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J  HE  CAliE  AND  FEEDIKG 
OF  CHILDREN 


L.  EMME^ 


«LT,  M.  D. 


Clement  R.  Troth, 

MEDICAL   BOOK-'. 

ists  stoat  Sreet 

Denver,  Colo. 


THE  LIBRARY 

OF 

THE  UNIVERSITY 

OF  CALIFORNIA 

LOS  ANGELES 


GIFT 


Richard  K,   Hughes,   M,D, 


Digitized  by  tine  Internet  Arcliive 

in  2007  witli  funding  from 

IVIicrosoft  Corporation 


littp://www.arcliive.org/details/carefeedingofcliiOOIioltiala 


THE  CARE  AND  FEEDING 
OF  CHILDREN 


A  CATECHISM    FOR    THE  USE  OF  MOTHERS 
AND  CHILDREN'S  NURSES 


L.   EMMETT  HOLT,  M.  D.,  LL.  D. 

PROFESSOR   OF   DISEASES   OF  CHILDREN  IN  THE  COLLEGE  OF  PHYSICIANS 

AND    SURGEONS    (COLUMBIA    UNIVERSITY) 

ATTENDING  PHYSICIAN    TO    THE    BABIES*    HOSPITAL    AND    THE 

FOUNDLING    HOSPITAL,   NEW    YORK 


^bitti  <(EDition,  Slcbij^eti  an5  Cnlargeb 


NEW  YORK  AND  LONDON 

D.  APPLETON   AND   COMPANY 

1904 


Copyright,  1894,  1897,  1904 
By  D.   APPLETON   AND   COMPANY 


PRINTED    AT    THE    APPLETON    PRESS 
NEW   YORK,  U.  S.  A. 


TO 
THE  YOUNG  MOTHEES  OF  AMERICA, 

TOWARD  THE   SOLUTION  OF  WHOSE  PROBLEMS 
THESE  PAGES  HAVE  BEEN  DEVOTED, 

THIS   THIRD  EDITION 

IS     EESPECTFULLT     DEDICATED 

BY  THE  AUTHOR. 


113 
H7Uc 


PEEFACE    TO    THE    THIRD    EDITION 


Eight  years  of  constant  use  of  the  Catechism  as 
a  manual  for  nursery  maids  have  shown  the  need  of 
much  fuller  treatment  of  several  subjects,  notably 
that  of  infant  feeding,  than  was  given  in  the  earlier 
editions.  The  same  want  has  been  expressed  by 
mothers  and  nurses  outside  of  institutions  who  have 
made  the  book  a  nursery  guide. 

The  section  upon  Infant  Feeding  has,  therefore, 
been  almost  entirely  rewritten  and  much  new  material 
introduced,  especially  that  relating  to  the  selection 
and  care  of  cow's  milk,  and  its  preparation  and  use 
in  infant  feeding.  An  effort  has  been  made  in  the 
present  volume  to  state  more  fully  the  principles 
underlying  infant  feeding,  a  knowledge  of  which  is 
indispensable  to  the  nurse  or  mother  who  would  cope 
successfully  with  this  difficult  problem. 

Much  more  space  has  been  given  in  this  edition  to 
the  nursing  infant.  Many  other  points  relating  to 
growth,  training,  toys,  etc.,  have  been  touched  upon 

6 


6    THE  CARE  AND  FEEDING  OP  CHILDREN 

for  the  first  time,  so  that  the  size  of  the  book  has  been 
increased  by  nearly  one  half. 

The  author's  aim  has  been  not  to  alarm  the  mother 
by  acquainting  her  with  all  the  possible  diseases  and 
accidents  which  may  befall  her  infant,  but  to  open  her 
eyes  to  matters  which  are  her  direct  and  chief  con- 
cern. 

It  is,  therefore,  the  needs  of  the  well  child,  not  the 
sick  one,  which  have  been  considered.  The  well  child 
must,  in  most  cases,  be  left  to  the  care  of  the  mother 
or  nurse  for  whose  guidance  and  assistance  these 
pages  are  intended.  For  directions  in  matters  of  ill- 
ness, however,  no  mother  or  nurse  should  depend  upon 
any  manual,  but  upon  the  advice  of  a  physician. 

To  Miss  Marianna  Wheeler,  superintendent  of 
the  Babies'  Hospital,  whose  long  experience  in  train- 
ing nurses  has  made  her  a  most  competent  judge  of 
their  needs,  I  am  indebted  for  many  valuable  sugges- 
tions. 

It  is  believed  that  the  mothers  and  nurses  who 
have  found  the  earlier  editions  of  the  Catechism  help- 
ful in  the  solution  of  some  of  their  nursery  problems 
will  find  even  greater  assistance  from  the  present 
volume. 

New  Yoek,  January,  190S. 


PEEFACE    TO    THE   FIEST    EDITION 


"When  in  the  fall  of  1889  the  Practical  Training 
School  for  Nursery  Maids  was  opened  in  connection 
with  the  Babies'  Hospital  of  New  York,  the  need  was 
soon  felt  for  some  simple  manual  to  put  into  the  hands 
of  the  nurses.  None  could  be  found  which  fulfilled 
the  requirements  of  simplicity,  brevity,  and  exactness 
with  reference  to  matters  of  infant  feeding  and  nurs- 
ery hygiene. 

A  series  of  questions  was  written  out  by  the  au- 
thor for  the  purpose  of  formulating  for  the  nurses 
under  training  those  things  which  were  matters  of 
daily  observation  in  the  practical  work  of  the  Hospi- 
tal. From  time  to  time  additions  have  been  made  to 
these,  until  the  present  size  has  been  reached. 

This  Catechism  is  now,  at  the  request  of  many 
friends,  published,  with  the  hope  that  it  may  serve  a 
useful  purpose  in  other  institutions  where  similar 
schools  for  training  may  be  established.  At  the  same 
time,  it  is  thought  that  it  may  be  of  value  to  many 

7 


8    THE  CARE  AND  FEEDING  OP  CHILDREN 

mothers  in  the  care  of  their  own  children,  or  a  book 
which  they  may  safely  put  into  the  hands  of  the  ordi- 
nary (untrained)  child's  nurse. 

In  the  preparation  of  this  Catechism  everything 
has  been  sacrificed  to  clearness  and  simplicity.  It 
has  been  deemed  best  to  emphasize  strongly  the  es- 
sentials, without  going  into  many  minor  details  which 
would  have  increased  materially  the  size  of  the  book 
without  adding  to  its  usefulness.  The  style  of  ques- 
tion and  answer  has  been  adopted  in  order  to  impress 
more  strongly  the  facts  stated. 

March,  1894. 


CONTENTS 


I 

THE  CAEE  OF  CHILDREN 

PAGE 

Bathing 13 

Eyes 14 

Mouth .  14 

Skin 15 

Clothing 17 

Napkins 20 

Nursery 21 

Airing 23 

Weight,  growth,  development 26 

Dentition 32 

n 

THE  FEEDING  OF  CHILDREN 

Nursing 36 

Weaning 42 

Artificial  feeding 45 

Selection  and  care  of  milk  used  for  infant  feeding         .        .  46 

Refrigerators 49 

Modification  of  cow's  milk 50 

Food  for  the  early  months 58 

Pood  for  the  middle  months 62 

9 


10    THE  CARE  AND  FEEDING  OF  CHILDREN 


PA03 

Food  from  ten  to  fifteen  months Go 

General  rules  for  guidance  in  feeding 66 

The  addition  of  other  foods  to  milk 70 

Over-feeding 73 

Changes  in  the  food  required  by  special  symptoms         .        .  74 

Preparation  of  cow's  milk  at  home 81 

Directions  for  feeding  infants 84 

Intervals  of  feeding 86 

Regularity  in  feeding 88 

Sterilized  milk 89 

Pasteurized  milk 93 

Modified  milk  of  the  milk  laboratories 93 

Peptonized  milk 94 

Feeding  during  the  second  year 97 

Feeding  of  older  children 102 

Articles  allowed  from  third  to  seventh  year    ....  104 

Articles  forbidden  from  third  to  seventh  year        .        .        .  107 

General  rules  to  be  observed  in  feeding   .        .        .        .        .  108 
Food  formulas : 

Beef  juice,  110 ;  mutton  broth,  111 ;  chicken,  veal, 
beef  broths,  112;  meat  pulp,  112;  Junket,  curds  and 
whey,  112;  whey,  112;  barley  jelly,  113;  barley  water, 
113 ;  oat,  wheat,  rice  jelly,  114  ;  imperial  granura,  114; 
albumin  water,  114;  lime  water,  114;  dried  bread,  115; 
coddled  egg,  115. 

m 

MISCELLANEOUS 

Bowels 116 

Sleep 118 

Causes  of  disturbed  sleep 120 

Exercise 123 

Cry 123 

Lifting  children .  125 


CONTENTS  11 


PAGE 

Temperature      .        .        * 126 

Nervousness 128 

Playing  with  babies 128 

Toys 129 

Kissing 131 

Convulsions 131 

Foreign  bodies  swallowed 132 

Foreign  bodies  in  the  ear          .......  133 

Foreign  bodies  in  the  nose .  133 

Colic 133 

Earache     . 134 

Croup 135 

Contagious  diseases 136 

Treatment  for  commencing  illness 140 

Nursery  training  to  help  the  doctor 141 

Scurvy 141 

Constipation 143 

Diarrhoea 145 

Bad  habits 146 


THE   CARE  AND  FEEDING  OF 
CHILDREN 


I 

THE   CAEE  OF   CHILDEEN 

BATHING 

At  what  age  may  a  child  he  given  a  full  tub  hath? 
Usually  when  ten  days  old;   it  should  not  be 
given  before  the  cord  has  come  off. 

How  should  the  hath  he  given? 

It  should  not  be  given  sooner  than  one  hour  after 
feeding.  The  room  should  be  warm;  if  possible 
there  should  be  an  open  fire.  The  head  and  face 
should  first  be  washed  and  dried;  then  the  body 
should  be  soaped  and  the  infant  placed  in  the  tub 
with  its  body  well  supported  by  the  hand  of  the 
nurse.  The  bath  should  be  given  quickly,  and  the 
body  dried  rapidly  with  a  soft  towel,  but  with  very 
little  rubbing. 

At  what  temperature  should  the  hath  he  given? 
For  the  first  few  weeks  at  100°  F. ;  later,  dur- 
ing early   infancy,    at   98°   F. ;    after   six  months, 

13 


14        THE  CARE  AND  FEEDING  OF  CHILDREN 

at  95°  F. ;  during  the  second  year,  from  85°  to 
90°  F. 

Should  a  child  he  bathed  whose  body  is  covered 
with  an  eruption? 

Not  as  a  rule,  unless  a  physician  has  seen  the 
case.  Harm  is  often  done  in  eczema  and  many  other 
skin  diseases  by  bathing  with  soap  and  water. 

BYES 

How  should  the  eyes  of  a  little  baby  be  cleansed? 

With  a  piece  of  soft  linen  and  a  lukewarm  solu- 
tion of  salt  or  boric  acid, — one  fourth  of  an  even 
teaspoonful  to  one  pint  of  water. 

If  pus  appears  in  the  eyes,  what  should  be  done  ? 

They  should  be  cleansed  every  hour  with  a  solu- 
tion of  boric  acid  (ten  grains  to  one  ounce  of  water). 
If  the  lids  stick  together,  a  little  vaseline  from  a  tube 
should  be  rubbed  upon  them  at  night.  If  the  trouble 
is  slight,  this  treatment  will  control  it ;  if  it  is  severe, 
a  physician  should  be  called  immediately,  as  delay 
may  result  in  loss  of  eyesight. 

MOFTH 

How  is  an  infant's  mouth  to  be  cleansed? 
An  excellent  method  is  by  a  swab  made  by  twist- 
ing a  bit  of  absorbent  cotton  upon  a  wooden  tooth- 


SKIN  16 

pick.  With  this  the  folds  between  the  gums  and  lips 
and  cheeks  may  be  gently  and  carefully  cleansed 
twice  a  day  unless  the  mouth  is  sore.  It  is  not 
necessary  after  every  feeding.  The  finger  of  the 
nurse,  often  employed,  is  too  large  and  liable  to 
injure  the  delicate  mucous  membrane. 

What  is  sprue? 

It  appears  on  the  lips  and  inside  the  cheeks  like 
little  white  threads  or  flakes.  It  is  also  called  thrush. 
In  bad  cases  it  may  cover  the  tongue  and  the  whole 
of  the  inside  of  the  mouth. 

How  should  a  mouth  he  cleansed  when  there  is 
sprue ? 

It  should  be  washed  carefully  after  every  feeding 
or  nursing  with  a  solution  of  borax  or  bicarbonate  of 
soda  (baking  soda),  one  even'teaspoonful  to  three 
ounces  of  water,  and  four  times  a  day  the  boric-acid 
solution  mentioned  should  be  used. 

SKIN 

How  should  the  infant's  shin  he  cared  for  io 
prevent  chafing? 

First,  not  too  much  nor  too  strong  soap  should  be 
used ;  secondly,  careful  rinsing  of  the  body ;  thirdly, 
not  too  vigorous  rubbing,  either  during  or  after  the 
bath;  fourthly,  the  very  free  use  of  dusting  powder 


16    THE  CARE  AND  FEEDING  OF  CHILDREN 

in  all  the  folds  of  the  skin, — under  the  arms,  behind 
the  ears,  about  the  neck,  in  the  groin,  etc.  This  is 
of  the  utmost  importance  in  very  fat  infants. 

If  the  skin  is  very  sensitive  and  chafing  easily 
produced,  what  should  be  done? 

'No  soap  should  be  used,  but  bran  or  salt  baths 
given  instead. 

How  should  a  bran  bath  be  prepared? 

One  pint  of  wheat  bran  should  be  placed  in  a  bag 
of  coarse  muslin  or  cheese-cloth,  and  this  put  in  the 
bath  water.  It  should  then  be  squeezed  for  five  min- 
utes, until  the  water  resembles  a  thin  porridge. 

How  should  a  salt  bath  be  prepared? 
A  teacupful  of  common  salt  or  sea  salt  should  be 
used  to  each  two  gallons  of  water. 

How  should  the  buttocks  be  cared  for? 

This  is  the  most  common  place  for  chafing,  as  the 
parts  are  so  frequently  wet  and  soiled ;  hence  the  ut- 
most pains  should  be  taken  that  all  napkins  be  re- 
moved as  soon  as  they  are  wet  or  soiled,  and  the  parts 
kept  scrupulously  clean. 

//  the  parts  have  become  chafed,  what  should  be 
done? 

Only  bran  and  salt  baths  should  be  used,  and  in 
very  severe  cases  even  these  may  have  to  be  omitted 


CLOTHING  17 


for  a  day  or  two.  The  parts  may  be  cleaned  with 
sweet  oil  and  a  little  absorbent  cotton,  and  the  skin 
kept  covered  with  a  dusting  powder  composed  of 
starch  two  parts,  boric  acid  one  part. 

What  is  prickly  heat,  and  how  is  it  pro- 
duced? 

It  consists  of  fine  red  pimples,  and  is  caused  by 
excessive  perspiration  and  the  irritation  of  flannel 
underclothing. 

How  should  it  he  treated? 

Muslin  or  linen  should  be  put  next  to  the  skin; 
the  entire  body  should  be  sponged  frequently  with 
equal  parts  of  vinegar  and  water,  and  plenty  of  the 
starch  and  boric-acid  powder  mentioned  should  be 
used. 

CLOTHING 

What  are  the  most  essential  things  in  the  clothing 
of  infants? 

That  the  chest  shall  be  covered  with  soft  flannel, 
the  limbs  well  protected  but  not  confined,  and  the 
abdomen  supported  by  a  broad  flannel  band,  which 
should  be  snug  but  not  too  tight.  It  is  important 
that  the  clothing  should  fit  the  body.  If  it  is  too 
tight  it  interferes  with  the  free  movements  of  the 
chest  in  breathing,  and  by  pressing  upon  the  stomach 

sometimes  causes  the  infant  to  vomit  soon  after  swal- 
2 


18        THE  CARE  AND  FEEDING  OF  CHILDREN 

lowing  its  food.  If  the  clothing  is  too  loose  it  is 
soon  thrown  into  deep  folds  or  bunches,  which  cause 
much  discomfort.  No  pins  should  be  used,  but,  in- 
stead, all  bands  about  the  body  should  be  basted. 
The  petticoats  should  be  supported  by  shoulder 
straps. 

How  should  the  infant  he  held  during  dressing 
and  undressing? 

Nothing  is  more  awkward  than  to  attempt  to 
dress  a  young  baby  in  a  sitting  posture.  It  should 
lie  upon  the  nurse's  lap  until  quite  old  enough  to 
sit  alone,  the  clothing  being  drawn  over  the  child's 
feet,  not  slipped  over  the  head. 

Of  what  v^e  is  the  hand  ? 

It  protects  the  abdomen,  but  its  most  important 
use  is  to  support  the  abdominal  walls  in  very  young 
infants,  and  in  this  way  to  prevent  the  occurrence  of 
rupture. 

How  long  is  this  hand  required? 

The  snug  flannel  band,  not  usually  more  than 
four  months.  In  healthy  infants  this  may  then  be 
replaced  by  the  knitted  band,  which  may  be  worn  up 
to  eighteen  months.  The  band  is  an  important  ar- 
ticle of  dress  in  the  case  of  thin  infants  whose  ab- 
dominal organs  are  not  suflSciently  protected  by  fat. 


CLOTHING  19 


With  such,  or  with  those  prone  to  diarrhoea,  it  is 
often  advisable  to  continue  the  band  until  the  third 
year. 

What  changes  are  to  he  made  in  the  clothing  of 
infants  in  the  summer? 

Only  the  thinnest  gauze  flannel  undershirts 
should  be  worn,  and  changes  in  temperature  should 
be  met  by  changes  in  the  outer  garments.  The  great- 
est care  should  be  taken  that  children  are  not  kept 
too  hot  in  the  middle  of  the  day,  while  extra  wraps 
should  be  used  morning  and  evening,  especially  at 
the  seashore  or  in  the  mountains. 

Should  older  children  he  allowed  to  go  with  their 
legs  hare? 

If  strong  and  well  there  is  no  objection  to  this  in 
very  hot  weather.  In  cold  weather,  however,  it  is 
doubtful  if  any  children  are  benefited  by  it,  particu- 
larly in  a  changeable  climate  like  that  of  New  York. 
Many  delicate  children  are  certainly  injured  by  such 
attempts  at  hardening. 

What  sort  of  underclothing  should  he  worn  dur- 
ing cold  weather? 

Never  the  heaviest  weight,  even  in  winter.  Four 
grades  are  usually  sold,  the  next  to  the  heaviest  being 
thick  enough  for  any  child. 


20        THE  CARE  AND  FEEDING  OF  CHILDREN 

Do  little  children  require  as  heavy  flannels  as 
older  people  ? 

Not  as  a  rule.  They  usually  live  in  a  warm 
nursery ;  their  circulation  is  active ;  and  they  always 
perspire  easily  during  their  play.  When  they  go  out 
of  doors,  the  addition  of  coats  and  leggings  renders 
thick  flannels  unnecessary. 

Are  not  many  little  children  clothed  too  thinly 
for  the  ordinary  house? 

Very  few.  The  almost  invariable  mistake  made 
in  city  homes  is  that  of  excessive  clothing  and  too 
warm  rooms.  These  two  things  are  among  the  most 
frequent  reasons  for  their  taking  cold  so  easily. 

NAPKINS 

How  should  naphins  he  taken  care  of? 

They  should  be  immediately  removed  from  the 
nursery  when  soiled  or  wet.  Soiled  napkins  should 
be  kept  in  a  receptacle  with  a  tight  cover,  and  washed 
as  soon  as  possible. 

Should  napkins  which  have  been  only  wet  he 
used  a  second  time  without  washing? 

It  is  no  doubt  better  to  use  only  fresh  napkins, 
but  there  is  no  serious  objection  to  using  them  twice 
unless  there  is  chafing  of  the  skin.     Clean  napkins, 


NURSERY  21 


changed  as  soon  as  wet  or  soiled,  are  of  much  im- 
portance in  keeping  the  skin  healthy. 

What  are  the  important  things  to  he  observed  in 
washing  napkins? 

Soiled  napkins  should  not  be  allowed  to  dry,  but 
should  receive  a  rough  washing  at  once ;  they  should 
then  be  kept  in  soak  in  plain  water  until  a  conve- 
nient time  for  washing, — every  day  or  every  other 
day, — when  they  should  be  washed  in  hot  suds  and 
boiled  at  least  fifteen  minutes.  Afterward  they 
should  be  very  thoroughly  rinsed  or  they  may  irri- 
tate the  skin,  and  ironed  without  starch  or  blueing. 
They  should  never  be  used  when  damp. 

NUESEEY 

What  are  the  essentials  in  a  good  nursery? 

As  large  a  room  as  possible  should  be  selected — 
one  that  is  well  ventilated,  and  always  one  in  which 
the  sun  shines  at  some  part  of  the  day,  as  it  should 
be  remembered  that  an  average  child  spends  here 
at  least  three  fourths  of  its  time  during  the  first 
year.  The  nursery  should  have  dark  shades  at  the 
windows,  but  no  extra  hangings  or  curtains;  about 
the  baby's  crib  nothing  but  what  can  be  washed 
should  be  allowed.  The  air  should  be  kept  as  fresh 
and  as  pure  as  possible.     There  should  be  no  plumb- 


22        THE  CARE  AND  FEEDING  OP  CHILDREN 

ing,  no  drying  of  napkins  or  clothes,  no  cooking  of 
food,  and  no  gas  burning  at  night.  A  small  wax 
night-light  answers  every  purpose. 

How  should  a  nursery  he  heated  f 

Best  by  an  open  fire ;  next  to  this  by  a  Franklin 
stove.  The  ordinary  hot-air  furnace  of  cities  has 
many  objections,  but  it  is  not  so  bad  as  steam  heat 
from  a  radiator  in  the  room.  A  gas  stove  is  even 
worse  than  this,  and  should  never  be  used,  except, 
perhaps,  for  a  few  minutes  during  the  morning 
bath. 

At  what  temperature  should  a  nursery  he  hept 
during  the  day? 

Best,  66°  to  68°  F.,  measured  by  a  thermometer 
hanging  three  feet  from  the  floor.  iN^ever  should  the 
temperature  be  allowed  to  go  above  70°  F. 

At  what  temperature  during  the  night? 

During  the  first  two  or  three  months,  not  below 
65°  F.  After  three  months  the  temperature  may  go 
as  low  as  55°  F.  After  the  first  year  it  may  be  50° 
or  even  45°  F. 

At  what  age  may  the  window  he  left  open  at 
night  ? 

Usually  after  the  third  month,  except  when  the 
outside  temperature  is  below  freezing  point. 


AIRING  23 

Uow  often  should  the  nursery  he  aired? 

At  least  twice  a  day — in  the  morning  after  the 
child's  bath,  and  again  in  the  evening  before  the 
child  is  put  to  bed  for  the  night.  This  should  be 
done  thoroughly^  and  the  child  should  be  removed 
meanwhile  to  another  apartment.  It  is  well  to  air 
the  nursery  whenever  the  child  is  out  of  the  room. 

What  symptoms  are  seen  in  a  child  who  is  kept 
in  too  hot  a  room? 

It  becomes  pale,  loses  appetite,  shows  symptoms 
of  indigestion,  occasionally  vomits,  stops  gaining  in 
weight,  perspires  very  much,  and  takes  cold  easily 
because  of  this  and  also  because  of  the  great  differ- 
ence between  the  indoor  and  outdoor  temperatures. 
Its  condition  may  be  such  as  to  lead  one  to  suspect 
very  serious  illness. 

AIEING 

At  what  age  may  a  child  go  out  of  doors  in  the 
fall  and  spring? 

Usually  at  one  month.  In  the  summer  it  may  go 
out  when  one  week  old. 

When  in  winter? 

Airing  in  the  room  may  be  begun  when  the  child 
is  one  month  old,  at  first  only  fifteen  or  twenty  min- 
utes at  a  time.     At  three  months  it  may  go  out  on 


24         THE  CARE  AND  FEEDING  OF  CHILDREN 

pleasant  days,  being  kept  in  the  sun  and  out  of  the 
wind^ 

What  are  the  best  hours  for  airing  out  of  doors? 

In  summer  and  early  autumn  a  child  may  be  out 
almost  any  time  between  seven  in  the  morning  and 
sunset;  in  winter  and  early  spring,  a  young  child 
only  between  10  or  11  a.  m.  and  3  p.  m.,  although 
this  depends  somewhat  upon  the  climate.  In  New 
York  and  along  the  Atlantic  coast  the  early  morn- 
ings are  apt  to  be  damp  and  the  afternoons  raw  and 
cloudy. 

On  what  kind  of  days  should  a  haby  not  go  out? 

In  sharp  winds,  when  the  ground  is  covered  with 
melting  snow,  and  when  it  is  extremely  cold,  A  child 
under  four  months  old  should  not  usually  go  out  if 
the  thermometer  is  below  freezing  point;  nor  one 
under  eight  months  old  if  it  is  below  20°  F. 

What  are  the  most  important  things  to  he  at- 
tended to  when  the  child  is  out  in  its  carriage  ? 

To  see  that  the  wind  never  blows  in  its  face,  that 
its  feet  are  properly  covered  and  warm,  and  that  the 
sun  is  never  allowed  to  shine  directly  into  its  eyes 
when  the  child  is  either  asleep  or  awake. 

Of  what  advantage  to  the  child  is  going  out  ? 
Fresh  air  is  required  to  renew  and  purify  the 


AIRING  85 

blood,  and  this  is  just  as  necessary  for  health  and 
growth  as  proper  food. 

What  are  the  effects  produced  in  infants  by  fresh 
air? 

The  appetite  is  improved,  the  digestion  is  better, 
the  cheeks  become  red,  and  all  signs  of  health  are 
seen. 

Is  there  any  advantage  in  having  a  child  take  its 
airing  during  the  first  five  or  six  months  in  the 
nurse's  arms? 

None  whatever.  A  child  can  be  made  much  more 
comfortable  in  a  baby  carriage,  and  can  be  eqiially 
well  protected  against  exposure  by  blankets  and  the 
carriage  umbrella. 

What  are  the  objections  to  an  infant's  sleeping 
out  of  doors? 

There  are  no  real  objections.  It  is  not  true  that 
infants  take  cold  more  easily  when  asleep  than 
awake,  while  it  is  almost  invariably  the  case  that 
those  who  sleep  out  of  doors  are  stronger  children 
and  less  prone  to  take  cold  than  others. 

What  can  be  done  for  children  who  take  cold 
upon  the  slightest  provocation? 

They  should  be  kept  in  cool  rooms,  especially 
when   asleep.     They  should  not  wear   such  heavy 


26        THE  CARE  AND  FEEDING  OP  CHILDREN 

clothing  that  they  are  in  a  perspiration  much  of  the 
time.  Every  morning  the  body,  particularly  the 
chest  and  back,  should  be  sponged  with  cold  water 
(50°  to  60°  F.). 

How  should  this  cold  sponge  hath  he  given? 

The  child  should  stand  in  a  tub  containing  a 
little  warm  water,  and  a  large  bath  sponge  filled  with 
cold  water  should  be  squeezed  two  or  three  times 
over  the  body.  This  should  be  followed  by  a  vigor- 
ous rubbing  with  a  towel  until  the  skin  is  quite  red. 
This  may  be  used  at  three  years,  and  often  at  two 
years.  For  infants  a  little  higher  temperature  (65° 
to  70°)  may  be  used. 

WEIGHT,    GROWTH,    AND   DEVELOPMENT 

Of  what  importance  is  the  weight  of  the  child? 

IN'othing  else  tells  so  accurately  how  well  it  is 
thriving. 

During  the  first  year  a  record  of  the  weight  is 
almost  indispensable;  throughout  childhood  it  is  of 
much  interest  and  is  the  best  guide  to  the  physical 
condition.  It  will  well  repay  any  mother  or  nurse 
to  keep  such  a  record. 

How  frequently  should  a  child  he  weighed? 
Every  week  during  the  first  six  months,  and  at 


WEIGHT,  GROWTH,  AND  DEVELOPMENT         27 

least  once  in  two  weeks  during  the  last  six  months 
of  the  first  year.  During  the  second  year  a  child 
should  be  weighed  at  least  once  a  month. 

How  rapidly  should  an  infant  gain  in  weight 
during  the  first  year? 

There  is  usually  a  loss  during  the  first  week  of 
from  four  to  eight  ounces ;  after  this  a  healthy  child 
should  gain  from  four  to  eight  ounces  a  week  up  to 
about  the  sixth  month.  From  six  to  twelve  months 
the  gain  is  less,  usually  from  two  to  four  ounces  a 
week. 

Is  it  to  he  expected  that  hottle-fed  infants  will 
gain  as  rapidly  as  those  who  are  nursed  f 

They  seldom  do  so  during  the  first  month; 
after  that  time  under  favourable  circumstances 
the  gain  is  usually  quite  as  regular,  and  during 
the  latter  half  of  the  first  year  it  is  likely  to 
be  more  continuous  than  in  a  nursing  infant, 
because  the  latter  usually  loses  weight  at  the  time 
of  weaning. 

Why  do  they  not  gain  so  rapidly  at  first  9 
It  takes  a  few  weeks  for  the  stomach  to  become 
accustomed  to  cow's  milk,  and  until  this  is  accom- 
plished it  is  necessary  to  make  the  milk  very  weak 
or  the  child's  digestion  will  be  upset. 


28        THE  CARE  AND  FEEDING  OF  CHILDREN 

For  a  child  of  average  weight  at  birth  (seven 
to  seven  and  a  half  pounds)  what  should  he  the 
weight  at  the  different  periods  during  the  first 
year? 

At  three  months  it  should  be  twelve  to  thirteen 
pounds;  at  six  months,  fifteen  to  sixteen  pounds; 
at  nine  months,  seventeen  to  eighteen  pounds;  at 
one  year,  twenty  to  twenty-two  pounds.  At  five 
months  a  healthy  child  will  usually  double  its 
weight,  and  at  twelve  months  it  will  usually  treble 
its  weight. 

Do  all  healthy  infants  gain  steadily  in  weight 
during  the  first  year? 

As  a  rule  they  do;  yet  it  is  seldom  the  case  that 
one  gains  every  week  for  the  entire  year.  With  most 
infants  there  are  from  time  to  time  periods  of  a  few 
weeks  in  which  no  gain  is  made.  These  are  more 
often  seen  from  the  seventh  to  the  tenth  month  and 
frequently  occur  when  the  child  is  cutting  teeth, 
sometimes  during  very  hot  weather. 

7s  it  true  that  every  infant  who  gains  rapidly  in 
weight  is  thriving  normally? 

Not  invariably.  Some  who  are  fed  upon  pre- 
pared infant  foods  increase  rapidly  in  weight  but 
not  in  strength,  nor  in  their  development  in  other 
respects. 


WEIGHT,  GROWTH,  AND  DEVELOPMENT  29 

Is  the  weight  of  as  much  value  in  the  second  year 
as  a  guide  to  the  child's  condition? 

After  the  first  year,  the  gain  in  weight  is  seldom 
continuous;  there  are  many  interruptions,  some  de- 
pend on  season,  and  others  often  occur  without  ap- 
parent cause. 

At  what  age  should  the  fontanel  close? 

The  average  is  about  eighteen  months.  It  sel- 
dom closes  earlier  than  fourteen  months,  and 
should  it  remain  open  at  two  years  something  is 
wrong. 

At  what  age  should  a  child  hold  up  its 
head? 

As  a  rule  during  the  fourth  month,  and  often 
during  the  third  month,  the  head  can  be  held  erect 
when  the  body  is  supported. 

When  does  an  infant  first  laugh  aloud? 
Usually  from  the  third  to  the  fifth  month. 

When  does  it  begin  to  reach  for  toys  and  handle 
them? 

Usually  from  the  fifth  to  the  seventh  month.. 

At  what  age  should  a  child  he  able  to  sit  and 
stand  alone? 

At  seven  or  eight  months  a  healthy  child  is  usu- 


30    THE  CARE  AND  FEEDING  OF  CHILDREN 

ally  able  to  sit  erect  and  support  the  body.  During 
the  ninth  and  tenth  months  are  usually  seen  the  first 
attempts  to  bear  the  weight  upon  the  feet,  and  at 
eleven  or  twelve  months  most  children  can  stand  with 
assistance. 

When  should  a  child  walk  alone'? 

The  first  attempts  are  generally  seen  in  the 
twelfth  or  thirteenth  month.  At  fifteen  or  sixteen 
months  the  average  child  is  able  to  run  alone. 

What  conditions  'postpone  these  events  f 
Prematurity,  a  very  delicate  constitution,  any 
severe  or  prolonged  illness,  and  especially  chronic 
disturbances  of  digestion  making  feeding  difficult. 
A  common  cause  of  late  sitting,  standing,  or  walk- 
ing is  rickets. 

Should  a  child  he  urged  to  walTc? 

!N^ever;  he  is  usually  quite  willing  to  do  so  as 
soon  as  his  muscles  and  bones  are  strong  enough. 
!None  of  the  contrivances  for  teaching  children  to 
walk  are  to  be  advised. 

When  do  children  begin  to  talk? 

Generally  at  one  year  a  child  can  say  "  papa  " 
and  "  mamma  "  or  other  single  words.  At  the  end 
of  the  second  year  the  average  child  is  able  to  put 
words  together  in  short  sentences. 


WEIGHT,  GROWTH,  AND  DEVELOPMENT  31 

//  at  two  years  the  child  makes  no  attempt  to 
speak,  what  should  be  suspected? 

Either  that  the  child  is  a  deaf-mute  or  that  it  is 
mentally  deficient,  although  this  is  occasionally  seen 
in  children  who  are  only  very  backward. 

Table  showing  the  Average  Weight,  Height,  and  Cir- 
cumference of  Head  and  Chest  of  Boys  • 

At  birth Weight 7|  pounds. 

Height 20^  inches. 

Chest 13i     " 

Head 14 

,    One  year Weight 20|  pounds. 

Height 29    inches. 

Chest 18 

Head 18       " 

Two  years  . .  .Weight 26^  pounds. 

Height 32J  inches. 

Chest 19 

Head 19       •' 

Three  years  .  .Weight 81    pounds. 

Height 35   inches. 

Chest 20 

Head 19J     " 

Four  years  . . .  Weight 85   pounds. 

Height 38    inches. 

Chest 20f     " 

Head 19|     " 

*  The  weights  for  the  first  four  years  are  without  clothes  ; 
those  for  five  years  and  after  are  with  ordinary  house  clothes. 

The  weight  of  girls  is  on  the  average  about  one  pound  less. 
They  are  about  the  same  in  height. 


32        THE  CARE  AND  FEEDING  OF  CHILDREN 

Five  years Weight 41    pounds. 

Height 4H  inches. 

Chest 21i      " 

Head 20i      " 

Six  years "Weight 45    pounds. 

Height 44    inches. 

Chest 23 

Seven  years  .  .Weight 49^  pounds. 

Height 46   inches. 

Chest 23i     " 

Eight  years. . .  Weight 54^  pounds. 

Height 48    inches. 

Chest 24i     " 

Nine  years  . .  .Weight 60   pounds. 

Height 50    inches. 

Chest 25 

Ten  years Weight 66i^  pounds. 

Height 52    inches. 

Chest...... 26       " 

DENTITION 

How  many  teeth  are  there  in  the  first  set? 
Twenty. 

What  is  the  time  of  their  appearance? 

The  two  central  lower  teeth  are  usually  the  first 
to  appear,  and  come  from  the  fifth  to  the  ninth 
month ;  next  are  the  four  upper  central  teeth,  which 
come  from  the  eighth  to  the  twelfth  month.  The 
other  two  lower  central  teeth  and  the  four  front 
double  teeth  come  from  the  twelfth  to  the  eighteenth 
month.     Then  follow  the  four  canine  teeth,  the  two 


DENTITION  33 


upper  ones  being  known  as  the  "  eye  teeth,"  and  the 
two  lower  as  the  "  stomach  teeth  " ;  they  generally 
come  between  the  eighteenth  and  the  twenty-fourth 
month.  The  four  back  double  teeth,  which  complete 
the  first  set,  come  between  the  twenty-fourth  and 
thirtieth  month. 

At  one  year  a  child  usually  has  six  teeth. 

At  one  and  a  half  years,  twelve  teeth. 

At  two  years,  sixteen  teeth. 

At  two  and  a  half  years,  twenty  teeth. 

What  are  the  causes  of  variation? 

The  appearance  of  teeth  varies  in  different  fami- 
lies; in  some  they  come  very  early,  in  others  much 
later.  The  teeth  may  come  late  as  a  result  of  pro- 
longed illness  and  also  from  rickets. 

What  symptoms  are  commonly  seen  with  teeth- 
ing? 

In  healthy  children  there  is  very  often  fretful- 

ness  and  poor  sleep  for  two  or  three  nights;  there 

may  be  loss  of  appetite,  so  that  only  one  half  the 

usual  amount  of  food  is  taken;  there  is  salivation 

or  drooling,  and  often  slight  fever;  there  may  be 

some  symptoms  of  indigestion,  such  as  vomiting  or 

the  appearance  of  undigested  food  in  the  stools.     In 

delicate  children  all  these  symptoms  may  be  much 

more  severe. 
8 


34        THE  CARE  AND  FEEDING  OF  CHILDREN 

How  long  do  these  symptoms  last? 
Usually  only  three  or  four  days;  but  there  may 
be  no  gain  in  weight  for  two  or  three  weeks. 

What  is  the  cause  of  most  of  the  other  symp- 
toms attributed  to  teething  ? 

Nearly  all  of  them  come  from  indigestion  due  to 
bad  feeding. 


n 

INFANT  FEEDING 

What  is  the  best  infant  food? 
Mother's  milk. 

Of  what  is  mothers  milk  composed? 
Thirteen    parts    solids    and    eighty-seven    parts 
water. 

What  are  the  solids? 

Fat,  sugar,  proteids,  and  salts. 

What  is  the  fat? 
The  cream. 

What  is  the  sugar? 

It  is  lactose,  or  milk  sugar. 

What  are  the  proteids? 
The  curd  of  the  milk. 

Are  all  these  elements  necessary? 
Yes;  we  cannot  expect  to  rear  a  healthy  infant 
unless  they  are  all  in  his  food. 

Of  what  use  is  the  fat? 

It  is  needed  for  the  growth  of  the  bones,  the 

85 


36        THE  CARE  AND  FEEDING  OF  CHILDREN 

nerves,  the  fat  of  the  body,  and  the  production  of 
heat. 

Of  what  use  is  the  sugar? 

It  is  needed  for  the  production  of  heat,  and  to 
make  fat  in  the  body. 

Of  what  use  are  the  proteids? 

They  are  needed  for  the  growth  of  the  cells  of  the 
body,  such  as  those  of  the  blood,  the  various  organs, 
and  the  muscles. 

Of  what  use  are  the  salts? 

Particularly  for  the  growth  of  bone. 

Of  what  use  is  the  water? 

By  means  of  the  water  the  food  is  kept  in  a  state 
of  minute  subdivision  or  in  solution,  so  that  the 
delicate  organs  of  a  young  infant  can  digest  it.  It 
is  also  necessary  to  enable  the  body  to  get  rid  of  its 
waste. 

NURSING 

Should  all  mothers  attempt  to  nurse  their  chil- 
dren ? 

As  a  rule  they  should  do  so,  but  there  are  many 
conditions  when  they  should  not. 

What  are  the  most  important  ones? 

If  the  mother  has  or  has  had  tuberculosis  or  any 
other  serious  chronic  disease,  or  is  herself  in  very 
delicate  health,  she  should  not  try.    She  is  likely  soon 


NURSING 


37 


to  fail  in  nourishing  her  child,  and  the  attempt  may 
do  herself  much  harm  as  well  as  injure  the  child. 

How  often  should  infants  he  nursed  during  the 
first  two  days  of  life? 

Usually  only  four  or  five  times  daily,  since  there 
is  very  little  milk  secreted  at  this  time. 

When  does  the  milk  come  in  abundance? 
Usually  on  the  third  day,  sometimes  not  until  the 
fourth  or  fifth  day. 

Should  the  infant  he  fed  anything  additional 
during  the  first  two  days? 

Usually  not;  if  much  food  vrere  necessary,  we 
may  be  sure  Nature  would  have  provided  it.  Water 
may  be  given  if  the  infant  shows  signs  of  thirst. 

How  frequently  should  an  infant  he  nursed  dur- 
ing the  first  week? 

After  the  third  day,  every  two  hours  during  the 
day  and  twice  during  the  night.  The  frequency 
during  the  rest  of  the  first  year  is  given  in  the  fol- 
lowing table: 


Period. 

Nursings  in 
84  hours. 

Interval  by  day. 

Night  nursings 

(10  P.M.  to  6  A.M.) 

1st  and  2d  day 

3  days  to  6  weeks  . . . 
6  weeks  to  3  months. 

3  to  5  months 

5  to  12  months 

4 
10 
8 
7 
6 

6    hours. 

2 

2^      " 

3 

3 

1 
2 
2 

1 
0 

\ 


38         THE  CARE  AND  FEEDING  OF  CHILDREN 

How  long  should  the  child  he  kept  at  the  breast 
for  one  nursing? 

E^ot  over  twenty  minutes. 

Should  the  child  take  hath  breasts  at  one  nurs- 
ing? 

If  the  milk  is  very  abundant  one  breast  may  be 
sufficient,  otherwise  both  breasts  may  be  taken. 

What  are  the  important  things  to  he  attended  to 
in  nursing? 

First,  regularity;  it  is  just  as  important  as  in 
the  case  of  bottle-feeding.  Secondly,  the  nipples 
should  be  kept  clean  by  being  washed  after  every 
nursing. 

What  should  he  the  diet  of  a  nursing  mother? 

She  should  have  a  simple  but  generous  diet  with 
plenty  of  fluids;  three  regular  meals  may  be  given, 
and  gruel,  milk,  or  cocoa  at  bed-time  and  sometimes 
between  meals.  She  may  take  eggs,  cereals,  most 
soups,  and  nearly  all  vegetables,  avoiding  sour  fruits, 
salads,  pastry,  and  most  desserts.  Meat  should  not 
be  taken  more  than  twice  daily,  and  in  many  cases 
but  once.  She  should  take  but  little  tea  or  coffee, 
and  ordinarily  no  wine  or  beer. 

Are  fruits  likely  to  disturb  a  nursing  infant? 
Sour  fruits  in  rare  cases  may  do  so,  but  sweet 
fruits  and  most  cooked  fruits  are  useful. 


NURSING 


What  else  is  important  in  the  life  of  the  nursing 
mother? 

That  she  should  have  regular  out-of-door  exer- 
cise as  soon  after  her  confinement  as  her  condition 
will  permit;  that  she  should  be  as  free  as  possible 
from  unnecessary  cares  and  worry;  that  her  rest  at 
night  should  be  as  little  disturbed  as  possible,  and 
that  her  bowels  move  regularly  every  day. 

Do  the  emotions  of  the  mother  affect  the  milh? 

They  have  a  very  marked  effect  upon  it;  uncon- 
trolled emotions  such  as  grief,  excitement,  fright, 
passion,  or  excessive  worry,  or  even  extreme  fatigue, 
may  cause  the  milk  to  disagree  with  an  infant  or 
even  make  it  acutely  ill. 

Does  menstruation  affect  the  milk? 

In  nearly  all  cases  the  quantity  of  milk  is  less- 
ened so  that  the  infant  is  not  satisfied  and  may  gain 
less  in  weight  or  not  at  all.  In  many  cases  the  qual- 
ity of  the  milk  is  also  affected  to  such  a  degree  as  to 
cause  slight  disturbances  of  digestion,  such  as  rest- 
lessness, colic,  and  perhaps  some  derangement  of  the 
bowels.  In  a  few,  attacks  of  acute  indigestion  are 
excited. 

Is  regular  menstrv/ition  a  reason  for  stopping 
nursing  ? 

Not  invariably;  as  a  rale  both. functions  do  not 


40         THE  CARE  AND  FEEDING  OP  CHILDREN 

go  on  together.  But  if  the  child  is  gaining  regu- 
larly in  weight  between  the  periods,  nursing  may  be 
continued  indefinitely,  although  it  may  be  well  to 
feed  the  infant  wholly  or  in  part  during  the  first  day 
or  two  that  the  mother  is  unwell. 

What  symptoms  indicate  that  a  nursing  infant 
is  well  nourished? 

The  child  has  a  good  colour,  sleeps  for  two  or 
three  hours  after  nursing,  or,  if  awake,  is  quiet, 
good-natured,  and  apparently  comfortable.  It  has 
normal  movements  of  the  bowels  and  gains  steadily 
in  weight. 

What  are  the  symptoms  which  indicate  that  a 
child  who  is  nursing  is  not  properly  nourished? 

It  does  not  gain  in  weight,  cries  frequently, 
sleeps  irregularly,  is  always  uncomfortable,  suffers 
from  colic,  and  the  movements  contain  undigested 
food.  When  the  milk  is  scanty  it  will  often  nurse 
a  long  time  at  the  breasts,  sometimes  three  quarters 
of  an  hour,  before  stopping.  At  other  times  it  may 
take  the  breast  for  a  moment  only,  and  then  turn 
away  in  apparent  disgust. 

What  should  he  done  when  such  symptoms  ap- 
pear? 

This  depends  upon  the  severity  of  the  symptoms 
^'and  how  long  they  have  lasted.     If  the  child  has 


NURSING  41 


made  no  gain  for  three  or  four  weeks,  is  constantly 
uncomfortable,  and  has  symptoms  of  indigestion, 
nursing  should  be  stopped  entirely.  If  there  is 
some  gain  in  weight,  nursing  may  be  continued  and 
the  mother's  manner  of  life  altered  with  the  hope 
of  improving  the  milk.  The  bottle  may  be  given 
once  or  twice  in  twenty-four  hours,  or  at  all  the 
night  feedings. 

7s  there  any  objection  to  a  hahy  being  partly 
nursed  and  partly  fed? 

None  whatever;  it  is  often  better  from  the  out- 
set to  feed  the  baby  during  the  night,  in  order  not 
to  disturb  the  mother's  rest. 

What  changes  should  be  made  if  a  nursing  in- 
fant habitually  vomits? 

If  this  occurs  soon  after  nursing,  the  infant  has 
usually  taken  too  much  and  the  time  of  nursing 
should  be  shortened,  or  one  breast  may  be  given 
instead  of  two;  the  nursing  should  also  be  inter- 
rupted by  occasional  rests,  so  that  the  milk  is  not 
taken  too  fast. 

If  the  vomiting  occurs  some  time  after  nursing 
and  is  repeated,  it  is  a  sign  of  indigestion;  often 
because  the  milk  is  too  rich  in  fat.  The  intervals 
between  nursings  should  then  be  lengthened;  the 
breast  milk  may  be  diluted  by  giving  one  or  two 


42        THE  CARE  AND  FEEDING  OF  CHILDREN 

tablespoonfuls  of  plain  boiled  water,  lime-water,  or 
barley-water,  five  or  ten  minutes  before  nursing;  the 
mother  should  eat  less  hearty  food,  especially  less 
meat. 

What  should  he  done  if  the  infant  has  frequent 
or  habitual  colic? 

This  is  usually  because  the  milk  is  too  rich  in 
proteids;  the  mother  should  take  more  out-of-door 
exercise,  eat  less  meat,  and  seek  to  control  her  emo- 
tions; all  causes  of  worry  should  be  removed. 

Can  constipation  in  a  nursing  infant  be  con- 
trolled through  the  mothers  milk? 

Only  to  a  limited  extent.  It  is  important  that  the 
mother's  bowels  be  regular  and  her  digestion  good. 
An  increase  in  the  meat  and  milk  of  her  diet  is  some- 
times beneficial. 

WEANING 

At  what  age  should  the  child  be  weaned  from 
the  breast? 

Usually  weaning  should  be  begun  at  nine  or  ten 
months  by  substituting  one  feeding  a  day  for  one 
nursing,  later  two  feedings,  and  thus  gradually  the 
child  is  to  be  taken  from  the  breast  altogether. 

What  is  the  principal  reason  for  weaning  earlier? 

The  most  important  one  is  that  the  child  is  not 
thriving — not  gaining  in  weight  and  not  progressing 


WEANING  43 


normally  in  its  development.     Serious  illness  of  the 
mother,  or  pregnancy,  may  make  weaning  necessary. 

At  what  age  should  the  weaning  he  completed? 

Generally  at  one  year.  In  summer  it  may  some- 
times be  advisable  to  nurse  an  infant  a  little  longer 
rather  than  wean  in  warm  weather;  but  even  then 
the  dangers  of  weaning  are  much  less  than  those 
of  continuing  to  nurse,  as  is  so  often  done,  after 
the  milk  has  become  very  scanty  and  poor  in  quality. 

When  should  a  child  who  is  weaned  from  the 
breast  he  taught  to  drink  from  the  cup,  and  when 
to  take  the  hottle? 

If  weaning  is  done  as  early  as  the  eighth  or  ninth 
month  it  is  better  to  give  the  bottle;  if  at  the  elev- 
enth or  twelfth  month  the  infant  should  be  taught 
to  drink  or  be  fed  with  a  spoon. 

How  may  some  of  the  difficulties  in  weaning  he 
overcome? 

By  feeding  every  nursing  infant  once  a  day  or 
by  giving  it  water  regularly  from  a  feeding-bottle. 
It  then  becomes  accustomed  to  the  bottle.  This  is  a 
matter  of  great  convenience  during  the  whole  period 
of  nursing  when  the  mother  or  nurse  is  from  neces- 
sity away  from  the  child  for  a  few  hours,  and  when 
more  feeding  is  required  at  weaning  time  the  child 
does  not  object. 


44    THE  CARE  AND  FEEDING  OF  CHILDREN 

When  should  an  infant  he  loeaned  from  tJis 
loUle  f 

This  should  be  begun  at  the  end  of  the  first  year ; 
except  at  the  night  feeding  the  bottle  should  not  be 
given  after  a  child  is  fourteen  months  old. 

7s  there  any  objection  to  an  infant  taking  the 
hottle  until  two  or  three  years  old? 

There  are  no  advantages  and  some  serious  ob- 
jections. Older  infants  sometimes  become  so  at- 
tached to  the  bottle  that  it  is  only  with  the  greatest 
difficulty  that  they  can  be  made  to  give  it  up.  Many 
refuse  milk  altogether  as  soon  as  the  bottle  is  taken 
away,  and  cannot  be  made  to  take  milk  during  child- 
hood except  from  a  bottle.  Such  a  "  bottle  habit  "  is 
troublesome,  unnecessary,  and  should  be  prevented. 

Can  a  hahy  just  weaned  take  cow's  milk  of  the 
same  'proportions  as  one  of  the  same  age  who  has 
had  cow's  milk  from  hirth? 

Very  rarely ;  to  give  a  baby  who  has  had  nothing 
but  the  breast  from  birth,  plain  cow's  milk,  or  even 
that  milk  which  a  bottle-fed  baby  of  the  same  age 
might  take,  is  almost  certain  to  cause  indigestion. 
,  The  change  in  the  food  is  quite  a  marked  one,  and 
should  be  made  gradually  by  beginning  with  a  very 
weak  milk  and  increasing  its  strength  as  the  baby 
becomes  accustomed  to  take  cow's  milk. 


ARTIFICIAL  FEEDING  45 

What  would  he  the  proper  proportions  for  an  in- 
fant weaned  at  four  or  five  months? 

About  the  same  as  for  a  healthy  bottle-fed  infant 
of  two  months;  the  quantity  of  course  should  be 
larger.  The  food  can  in  most  cases  be  gradually  in- 
creased so  that  in  two  or  three  weeks  the  usual 
strength  for  the  age  can  be  taken. 

What  would  he  the  proper  proportions  for  an  in- 
fant weaned  at  nine  or  ten  months? 

About  the  same  as  for  a  bottle-fed  infant  at  four 
or  five  months,  to  be  increased  as  indicated  above. 

Will  not  a  child  lose  in  weight  when  placed  upon 
so  low  a  diet? 

Very  often  it  will  do  so  for  the  first  week  or  two, 
but  after  that  will  gain  quite  regularly ;  the  acute  in- 
digestion, however,  which  generally  accompanies  the 
use  of  stronger  milk  will,  in  most  cases,  cause  a 
greater  loss. 

AETIFICIAL  FEEDING 

What  foods  contain  all  the  elements  present  in 
mother's  milk? 

The  milk  of  other  animals, — cow's  milk  being 
the  only  one  which  is  available  for  use. 

7s  it  not  possible  for  infants  to  thrive  upon  other 
foods  than  those  containing  fresh  milk? 

They  may  do  so  for  a  time,  but  never  perma- 


46    THE  CARE  AND  FEEDING  OP  CHILDREN 

nently.     The  long-continued  use  of  other  foods  as 
the  sole  diet  is  attended  with  great  risk. 

What  are  the  dangers  of  such  foods  9 
Frequently  scurvy  is  produced  (see  page  141), 
often  rickets,  and  in  other  cases  simply  a  condition 
of  general  malnutrition, — the  child  does  not  thrive, 
is  pale,  and  its  muscles  soft  and  flabby. 

THE  SELECTION  AND  CAEE  OF  MILK  USED  FOE  INFANT 
FEEDING 

What  are  the  essential  'points  in  milk  selected  for 
the  feeding  of  infants? 

That  it  comes  from  healthy  cows,  and  that  it  is 
clean  and  fresh. 

Is  it  not  important  to  select  a  rich  milh? 

By  no  means ;  in  fact  the  very  rich  milk  of  high- 
ly bred  Jerseys  and  Alderneys  has  not  been  found 
nearly  so  satisfactory  in  infant  feeding  as  that  from 
some  other  herds,  such,  for  example,  as  the  common 
"  grade  cows." 

Which  is  the  better,  milk  from  one  cow  or  the 
mixed  milk  of  several  cows? 

The  mixed,  or  "  herd  milk,"  is  usually  to  be  pre- 
ferred, since  it  varies  little  from  day  to  day;  while 
that  from  a  single  cow  may  vary  considerably. 


THE  SELECTION  AND  CARE  OF  MILK  47 

How  fresh  is  it  important  that  cow's  milk  should 
he  for  the  best  results  in  infant  feeding? 

This  depends  very  much  upon  the  season,  and 
how  carefully  milk  is  handled.  As  ordinarily  han- 
dled at  the  dairy  and  in  the  home,  milk  should  not 
be  used  for  infants  in  winter  after  it  is  forty-eight 
hours  old;  in  summer  not  after  it  is  twenty-four 
hours  old,  and  it  may  be  unsafe  in  a  much  shorter 
time.  When  handled  with  especial  care  milk  may 
be  safe  for  a  longer  time. 

What  are  the  two  essentials  in  handling  milk? 

1.  That  it  be  kept  clean  and  free  from  contami- 
nation. This  necessitates  that  cows,  stables,  and 
milkers  be  clean,  and  that  transportation  be  in  sealed 
bottles;  also  that  those  who  handle  the  milk  do  not 
come  in  contact  with  any  contagious  disease.  All 
milk-pails,  bottles,  cans,  and  other  utensils  with  which 
the  milk  comes  in  contact  should  be  sterilized  shortly 
before  they  are  used,  by  steam  or  boiling  water. 

2.  That  it  be  cooled  immediately  after  leaving 
the  cows,  and  kept  at  as  low  a  temperature  as  pos- 
sible ;  to  be  efficient  this  should  not  be  above  50°  F. 

Milk  produced  under  hygienic  conditions  and 
handled  with  special  care  is  sold  in  bottles  in  a  num- 
ber of  cities  under  the  name  of  "  certified,"  "  guar- 
anteed/' or  "  inspected  "  milk.    When  available  such 


48        THE  CARE  AND  FEEDING  OF  CHILDREN 

milk  should  be  used  for  infants.  Of  course  the  ex- 
tra care  bestowed  in  its  production  and  transporta- 
tion increases  the  cost  of  the  milk,  but  the  best  will 
usually  be  found  in  the  end  to  be  the  cheapest. 

How  should  milk  he  handled  in  the  home  when 
obtained  fresh  from  the  cows? 

That  to  be  used  for  infants  should  be  strained 
through  a  thick  layer  of  absorbent  cotton  or  several 
thicknesses  of  cheese-cloth  into  quart  glass  jars  or 
milk  bottles  which  should  be  covered  and  cooled  im- 
mediately, best  by  placing  the  bottles  quite  up  to 
their  necks  in  ice  water  or  cold  spring  water,  where 
they  should  stand  for  at  least  half  an  hour.  That 
required  for  children  who  take  plain  milk  may  now 
be  poured  into  half-pint  bottles,  stopped  with  cotton, 
and  put  in  the  ice-chest,  or  the  coolest  place  possible. 
This  first  rapid  cooling  is  very  important  and  adds 
much  to  the  keeping  qualities  of  the  milk.  Milk 
loses  its  heat  very  quickly  when  cooled  in  water, 
but  very  slowly  when  it  is  simply  placed  in  a  cold 
room.  After  standing  four  or  five  hours  the  top- 
milk  may  be  removed ;  after  twelve  to  sixteen  hours 
the  cream  may  be  removed. 

How  should  milk  he  handled  when  hottled  milk 
is  purchased? 

It  should  be  cooled  as  just  described,  as  its  tern- 


THE  SELECTION  AND  CARE  OP  MILK  49 

perature  is  usually  somewhat  raised  during  trans- 
portation. If  it  has  been  bottled  at  a  dairy,  the 
cream  or  the  top-milk  may  be  removed  after  an  hour 
or  so. 

How  should  milk  and  cream  he  handled  when 
they  are  purchased  in  hulk? 

Such  milk  should  never  be  used  for  infants  v^^hen 
it  is  possible  to  obtain  bottled  milk,  as  it  is  much 
more  liable  to  contamination.  Both  cream  and  milk 
should  be  poured  at  once  into  covered  vessels  and 
kept  in  the  coolest  place  possible.  The  cream  and 
top-milk  will  seldom  rise  upon  such  milk  with  any 
satisfactory  regularity. 

What  are  the  important  things  to  he  secured  in 
nursery  refrigerators  ? 

Absolute  cleanliness  is  essential;  hence  the  inner 
portion  should  be  of  metal.  Those  made  entirely 
of  metal  are  unsatisfactory  as  in  them  the  ice  melts 
very  quickly.  If  the  ordinary  metal  refrigerator 
sold  is  encased  in  a  wooden  box,  we  have  the  best 
form.  Another  easy  way  of  securing  the  same  result 
is  to  make  for  the  refrigerator  a  covering  or  "  cosey  " 
of  felt  or  heavy  quilting,  which  can  be  easily  re- 
moved when  wet  or  soiled. 

The  compartments  of  the  refrigerator  should  be 
80  arranged  that  the  bottles  of  milk  are  either  in 
4 


50    THE  CARE  AND  FEEDING  OP  CHILDREN 

contact  with  the  ice  or  very  near  it.  The  supply  of 
ice  should  be  abundant.  Often  the  amount  of  ice  is 
so  small,  and  the  bottles  so  far  away,  that  the  tem- 
perature of  the  milk  is  never  below  60°  or  65°  F. 
To  be  really  effective  a  refrigerator  should  have  a 
temperature  where  the  milk  is  placed  of  not  over 
50°  F.  The  temperature  should  be  tested  with  the 
nursery  thermometer  from  time  to  time  to  ascertain 
what  results  are  being  obtained.  Spoiled  milk  owing 
to  faulty  refrigerators  is  to  be  blamed  for  many  at- 
tacks of  acute  illness  among  infants.  I^Text  to  the 
feeding-bottles  it  is  the  one  thing  in  the  nursery 
which  should  receive  the  closest  attention. 


Can  cow's  milk  he  fed  to  infants  without  any 
changes ? 

itsTo ;  for  although  it  contains  essentially  the  same 
elements  as  mother's  milk,  they  are  not  in  the  same 
proportions. 

7s  this  a  matter  of  much  importance? 

It  is  of  the  greatest  importance.  There  are  few 
infants  who  can  digest  cow's  milk  unless  it  is 
changed.  To  change  cow's  milk  so  as  to  make  it 
more  nearly  resemble  mother's  milk  is  called  modify- 
ing cow's  milk. 


THE  MODIFICATION  OF  COW'S  MILK  51 

How  is  this  milk  whose  proportions  have  been 
changed  distinguished  from  the  original  unchanged 
milk? 

The  changed  milk  is  usually  called  "  modified 
milk " ;  the  original  unchanged  milk  is  known  as 
"  plain  milk,"  "  whole  milk,"  "  straight  milk,"  or 
is  referred  to  simply  as  "  milk." 

What  are  the  principal  differences  between  cow's 
milk  and  mother  s  milk? 

Cow's  milk  has  a  little  more  than  half  as  much 
sugar;  it  has  nearly  three  times  as  much  proteids 
and  salts;  its  proteids  are  much  more  difficult  of 
digestion ;  its  reaction  is  acid,  that  of  mother's  milk 
is  alkaline. 

Are  there  any  other  important  things  to  be  con- 
sidered ? 

Yes;  mother's  milk  is  always  fed  fresh  and  is 
practically  sterile.  Cow's  milk  is  generally  kept 
twenty-four  hours  and  sometimes  much  longer.  It 
is  always  to  a  greater  or  less  degree  contaminated  by 
dirt  and  germs,  the  number  of  which  increases  rap- 
idly (1)  with  the  age  of  the  milk;  (2)  in  proportion 
to  amount  of  the  dust  or  dirt  which  enters  it;  (3) 
with  any  increase  in  the  temperature  at  which  the 
milk  is  kept. 

It  is  just  as  important  for  success  in  infant  feed- 


52         THE  CARE  AND  FEEDING  OP  CHILDREN 

ing  that  these  conditions  receive  attention  as  that 
the  proportions  of  the  different  elements  of  the  milk 
are  right. 

How  is  the  acidity  of  cow's  milk  overcome? 

By  the  addition  of  lime-water  or  bicarbonate  of 
soda.  If  lime-water  is  used,  one  ounce  to  twenty 
ounces  of  food  is  generally  required ;  if  soda  is  used, 
twenty  grains  to  twenty  ounces  of  food. 

How  is  the  sugar  test  increased^ 

By  adding  milk  sugar  to  the  food;  one  ounce  to 
each  twenty  ounces  of  food  will  give  the  proper 
quantity  for  the  first  four  or  five  months.  This  will 
make  the  proportion  about  the  same  (between  6  and 
7  per  cent)  as  in  mother's  milk. 

How  should  the  sugar  he  prepared? 

Simply  dissolved  in  boiled  water ;  if  the  solution 
is  not  clear,  or  if  there  is  a  deposit  after  standing, 
it  should  be  filtered  by  pouring  through  a  layer  of 
absorbent  cotton,  half  an  inch  thick,  which  is  placed 
in  an  ordinary  funnel. 

Will  not  cane  {granulated)  sugar  answer  as 
well? 

Not  as  a  rule;  however,  there  are  many  infants 
who  get  on  very  well  when  cane  sugar  is  used.  It 
has  the  advantage  of  being  much  cheaper.     A  good 


THE  MODIFICATION  OF  COW'S  MILE  53 

grade  of  milk  sugar  is  somewhat  expensive,  costing 
from  twenty-five  to  sixty  cents  a  pound,  and  cheap 
samples  are  apt  to  contain  impurities. 

//  cane  sugar  is  used,  what  amount  should  he 
added? 

Considerably  less  than  of  the  milk  sugar.  Usu- 
ally about  half  the  quantity  (half  an  ounce  to  twenty 
ounces  of  food)  is  as  much  as  most  infants  can  di- 
gest. If  the  same  quantity  is  used  as  of  the  milk 
sugar,  the  food  is  made  unduly  sweet,  and  the  sugar 
is  likely  to  ferment  in  the  stomach  and  cause  colic. 

7s  not  the  purpose  of  the  sugar  to  sweeten  the 
food  in  order  to  make  it  palatable  ? 

Not  at  all;  although  it  does  that,  its  real  use  is 
to  furnish  one  of  the  essential  elements  needed  for 
the  growth  of  the  body,  and  the  one  that  is  required 
by  young  infants  in  the  largest  quantity. 

How  do  we  know  that  this  is  so? 

By  the  fact  that  in  good  breast  milk  the  amount 
of  sugar  is  greater  than  that  of  the  fat,  proteids,  and 
salts  combined. 

We  have  seen  that  cow's  milJc  has  nearly  three 
times  as  much  proteids  (curd)  and  salts  as  mother's 
milk.    How  are  these  to  he  diminished? 

By  diluting  the  milk. 


54        THE  CARE  AND  FEEDING  OP  CHILDREN 

Will  it  he  sufficient  to  dilute  the  milk  twice  {i.  e., 
add  two  parts  of  water  to  one  part  of  milk)? 

Not  for  a  very  young  infant.  Althougli  this  will 
give  about  the  quantity  of  proteids  present  in  moth- 
er's milk,  the  proteids  of  cow's  milk  are  so  much 
more  difficult  for  the  infant  to  digest,  that  in  the 
beginning  it  should  be  diluted  five  or  six  times  for 
most  infants. 

If  cow's  milk  is  properly  diluted  and  lime-water 
and  sugar  added  does  it  then  resemble  mothers 
milk? 

ITo;  the  mixture  contains  too  little  fat. 

What  is  the  easiest  way  of  overcoming  this? 

By  increasing  the  fat  in  the  milk  before  dilution. 
It  may  be  done  by  using  top-milk  or  a  mixture  of 
milk  and  cream. 

What  is  top-milk? 

It  is  the  upper  layer  of  milk  removed  after 
standing  a  certain  number  of  hours  in  a  milk  bottle, 
glass  jar,  or  any  tall  vessel  with  straight  sides.  The 
strength  of  the  top-milk  is  measured  by  the  fat  it 
contains — e.  g.,  a  10-per-cent  milk  contains  10  per 
cent  fat;  7-per-cent  milk  contains  7  per  cent  fat, 
etc.  The  amount  of  fat  depends  upon  the  propor- 
tion of  the  milk  removed. 


THE  MODIFICATION  OF  COW'S  MILK  55 

How  is  10-per-cent  top-milk  secured? 

Bj  removing  the  upper  third  of  the  milk,  or 
about  ten  ounces  from  a  quart,  after  standing  at 
least  four  hours. 

How  is  7-per-cent  top-milk  secured? 

By  removing  the  upper  half  or  sixteen  ounces 
from  a  quart. 

The  upper  third  and  the  upper  half  will  give  the 
percentage  of  fat  mentioned  with  a  good  milk  of 
average  richness,  which  contains  about  4  per  cent 
fat.  If  rich  Jersey  milk  is  used,  thirteen  ounces 
should  be  removed  from  a  quart  to  obtain  the  10-per- 
cent milk,  and  twenty  ounces  to  obtain  the  7-per-cent 
milk.  On  the  other  hand  if  the  milk  used  is  poor 
in  fat,  not  more  than  eight  ounces  can  be  removed 
having  10  per  cent  fat,  and  not  more  than  thirteen 
ounces  having  T  per  cent  fat. 

When  and  how  should  top-milk  he  removed? 

If  milk  fresh  from  the  cows  or  before  the  cream 
has  risen  be  put  into  bottles  and  rapidly  cooled,  the 
top-milk  may  be  removed  in  as  short  a  time  as  four 
hours.  In  the  case  of  bottled  milk  it  makes  little 
difference  if  it  stands  a  longer  time,  even  until  the 
next  day. 

This  should  not  be  poured  off.     It  may  be  re- 


sa 


56 


THE  MODIFICATION  OP  COWS  MILK  57 

moved  by  a  spoon  or  a  siphon,  but  the  best  method 
is  by  a  small  cream  dipper  ^  holding  one  ounce. 

What  is  cream? 

Cream  is  often  spoken  of  as  if  it  were  the  fat 
in  milk.  It  is  really  the  part  of  the  milk  which  con- 
tains most  of  the  fat.  It  differs  from  milk  chiefly 
in  containing  much  more  fat. 

In  what  ways  is  cream  now  obtained? 

(1)  By  skimming,  after  the  milk  has  stood  usu- 
ally for  twenty-four  hours ;  this  is  known  as  "  grav- 
ity cream."  (2)  By  an  apparatus  known  as  a  sepa- 
rator ;  this  is  known  as  "  centrifugal  cream  " ;  most 
of  the  cream  now  sold  in  cities  is  of  this  kind.  The 
richness  of  any  cream  is  indicated  by  the  amount  of 
fat  it  contains. 

The  usual  gravity  cream  sold  has  from  16  to  20 
per  cent  fat.  The  cream  removed  from  the  upper 
part  (one  fifth)  of  a  bottle  of  milk  has  about  16  per 
cent  fat.  The  usual  centrifugal  cream  has  18  to  20 
per  cent  fat.  The  heavy  centrifugal  cream  has  35 
to  40  per  cent  fat. 

^  Sold  by  James  Dougherty,  409  West  59th  Street,  for  20  cents. 
In  this  also  the  milk  sugar  can  be  measured,  2  scant  dipperfuls 
being  equal  to  one  ounce  of  sugar  by  weight.  If  tlie  sugar  is 
measured  in  a  tablespoon,  2^^  even  tablespoonfuls  may  be  calcu- 
lated as  one  ounce. 


58        THE  CARE  AND  FEEDING  OP  CHILDREN 


FOOD    FOE    THE    EAELY    MONTHS FIRST    PEEIOD 

What  relation  should  the  proteids  hear  to  the 
fat  in  the  early  months? 

They  should  be  about  one  third  the  fat,  the  pro- 
portion usually  present  in  mother's  milk. 

Is  this  necessary  throughout  the  first  year? 
It  is  not;   older   infants   can  usually   digest   a 
larger  proportion  of  proteids. 

How  can  the  proper  proportion  of  proteids  and 
fat  he  most  easily  secured? 

IB  J  using  for  dilution  a  10-per-eent  milk  (i.  e., 
milk  containing  10  per  cent  fat),  which  serves  as 
the  primary  formula  from  which  all  the  other  for- 
mulas for  this  period  are  derived.  In  10-per-cent 
milk  the  proteids  are  exactly  one  third  the  fat. 

How  can  we  get  the  10-per-cent  milk? 

(1)  As  top-milk,  using  the  upper  third  of  an 
average  milk  after  standing  as  described  on  page 
55.  (2)  By  mixing  equal  parts  of  plain  milk 
and  ordinary  cream  (containing  about  16  per  cent 
fat). 

7s  it  hetter  to  ohtain  the  10-per-cent  milk  hy 

using  a  mixture  of  milk  and  cream,  or  as  top-milk? 

If  one  can  get  milk  fresh  from  the  cows,  the  top- 


FOOD  FOR  THE  EARLY  MONTHS 


59 


milk  is  to  be  preferred  on  account  of  freshness.  The 
food  can  then  be  made  up  when  the  milk  is  but  a  few 
hours  old.  In  cities,  if  one  uses  bottled  milk  the 
upper  third  may  also  be  used.  But  if  one  buys  milk 
and  cream  separately,  it  is  usually  more  convenient 
to  mix  these,  as  the  cream  will  not  rise  upon  milk 
a  second  time  with  any  uniformity. 

How  should  milk  he  prepared  for  a  hdby  during 
the  early  months? 

It  is  convenient  to  make  up  twenty  ounces  of 
food  at  a  time.  The  first  step  is  to  obtain  the  10- 
per-cent  milk,  of  which,  for  the  first  two  or  three 
days,  not  more  than  two  ounces  should  be  used  in 
twenty  ounces  of  food ;  for  the  next  few  days,  three 
ounces ;  then,  for  a  few  days,  four  ounces,  etc.  There 
will  be  needed  also  one  ounce  of  lime-water  and  one 
ounce  of  milk  sugar  in  each  twenty  ounces.  The 
rest  of  the  food  will  be  boiled  water. 

These  formulas  written  out  would  be  as  follows : 

First  Series  of  Formulas— for  the  Early  Months 


I. 

n. 

m. 

IV. 

V. 

10-per-cent  milk . . 

Milk  sugar 

Lime-water 

Boiled  water 

2oz. 
1  " 
1   " 

17  " 

3oz. 

1  " 

1  " 

16  " 

4oz. 

1  " 
1  " 

15  " 

5  oz. 
1  " 
1  " 

14  " 

6oz. 

1  " 

1  " 

13  " 

20  oz. 

20  oz. 

20  oz. 

20  oz. 

20  oz. 

60 


THE  CARE  AND  FEEDING  OF  CHILDREN 


As  the  milk  sugar  dissolves  in  the  water  the  total 
in  each  column  will  be  exactly  twenty  ounces.  The 
food  is  strengthened  by  gradually  increasing  the 
milk  and  reducing  the  water. 

The  approximate  composition  of  these  formulas 
expressed  in  percentages  is  as  follows; 


Formula. 

Fat. 

Sugar. 

Protelda. 

I 

II 

1.00 
1.50 
2.00 
2.50 
3.00 

5.50 
6.00 
6.00 
6.00 
6.50 

0.83 
0  50 

Ill 

0  66 

IV 

0.80 

V 

1.00 

Why  is  it  necessary  to  make  the  food  so  weak 
at  first? 

Because  the  infant's  stomach  is  not  accustomed 
to  take  cow's  milk ;  but  if  we  begin  with  a  very  weak 
milk  the  stomach  can  be  gradually  trained  to  digest 
it.  If  we  began  with  a  strong  milk  the  digestion 
might  be  seriously  upset. 

How  rapidly  can  the  food  he  increased  in 
strength  from  Formula  I  to  II y  from  II  to  III,  etc.  ? 

No  absolute  rule  can  be  given.  Usually  we  begin 
with  I  on  the  second  day ;  II  on  the  fourth  day ;  III 
at  one  week  or  ten  days ;  but  after  that  make  the  in- 
crease more  slowly.     A  large  infant  with  a  strong 


FOOD  FOR  THE  EARLY  MONTHS       61 

digestion  will  bear  a  rather  rapid  increase  and  may 
be  able  to  take  V  by  the  time  it  is  three  or  four 
weeks  old.  A  delicate  child  with  a  feeble  digestion 
must  go  much  slower  and  may  not  reach  V  before 
it  is  ten  or  twelve  weeks  old.  It  is  important  with 
both  classes  to  increase  the  food  gradually,  always 
allowing  at  least  three  days  between  each  change. 

What  general  rule  can  he  given  for  increasing 
the  food? 

To  increase  when  the  infant  is  not  satisfied  but 
is  digesting  well. 

In  the  series  of  formulas  given  in  the  table  the 
quantities  are  mentioned  for  making  only  twenty 
ounces  of  food.  How  should  it  he  prepared  when 
more  than  this  quantity  is  needed? 

It  is  equally  convenient  to  make  up  25  ounces, 
30  ounces,  35  ounces,  or  40  ounces  at  a  time. 

To  make — 
25  ounces  of  any  formula  add  one  quarter  more  of  each  ingredient. 
30      "         "  *'  "   one  half  "        "  " 

85      "         "  "         "   three  quarters "       "  " 

40      "         "  "         "  twice  as  much  "  " 

Thus  25  ounces  of  Formula  I  would  be  obtained 
by  using  2^  ounces  of  milk,  1^  ounces  of  sugar  and 
lime-water,  21^  ounces  of  water;  30  ounces  of 
the  same  would  require  3  ounces  milk,  1^  ounces 


62    THE  CARE  AND  FEEDING  OP  CHILDREN 

lime-water  and  sugar,  and  25^  ounces  water;  35 
ounces  would  require  3^  ounces  milk,  If  ounces 
lime-water  and  sugar,  and  29f  ounces  water.  The 
amount  of  water  need  not  be  calculated  in  any  case, 
but  after  measuring  carefully  the  other  ingredients 
enough  water  should  be  added  to  bring  the  total  up 
to  the  amount  required. 

Would  not  increasing  the  quantity  sometimes  he 
better  than  increasing  the  strength  of  the  food? 

It  is  often  better  to  increase  the  quantity.  With 
most  infants  it  is  well  in  the  early  weeks  to  alter- 
nate, first  increasing  the  quantity,  then,  if  not  satis- 
fied, the  strength  of  the  food ;  the  next  time  increas- 
ing the  quantity  again,  etc. 

How  great  an  increase  in  the  quantity  should  he 
made  at  one  time? 

One  may  make  up  five  ounces  additional  food; 
but  the  first  two  days  only  three  ounces  of  the  addi- 
tional amount  should  be  given;  the  next  two  days, 
four  ounces;  after  two  days  more,  the  five  ounces 
may  be  given. 

FOOD   FOE   THE    MIDDLE    MOTTTHS SECOND    PEEIOD 

What  is  the  second  period  of  feeding? 

It  usually  begins  at  the  end  of  the  third  or  fourth 


FOOD  FOR  THE  MIDDLE  MONTHS  63 

month   and   continues  until   the  tenth   or   eleventh 
month. 

What  changes  may  he  made  in  the  milJc  of  a 
healthy  infant  in  this  period? 

A  higher  proportion  of  proteids  may  be  given. 
Instead  of  being  only  one  third  the  fat  as  in  the 
first  period,  they  may  now  be  made  one  half  the  fat. 

How  is  this  accomplished? 

By  using  for  dilution  instead  of  10-per-cent 
milk,  one  in  which  the  fat  is  only  7  per  cent;  for 
in  this  the  proteids  are  exactly  one  half  the  fat. 

How  is  7-per-cent  milk  obtained? 

(1)  As  top-milk,  by  taking  the  upper  half  after 
standing  as  described  on  page  55;  or  (2)  by  using 
one  fourth  ordinary  cream,  containing  16  per  cent 
fat,  and  three  fourths  plain  milk. 

Hoiu  is  the  food  prepared  using  the  7-per-cent 
milk? 

Very  much  like  that  with  the  10-per-cent  milk; 
twenty  ounces  are  made  up  at  one  time,  lime-water, 
milk  sugar,  and  boiled  water  being  added. 

What  further  additions  may  he  made? 
In  the  latter  part  of  the  second  period,  farina- 
ceous food  (see  page  70)  may  be  added  to  the  milk, 


64        THE  CARE  AND  FEEDING  OP  CHILDREN 


this  taking  the  place  of  part  of  the  water  and  part 
of  the  sugar. 

Second  Series  of  Formulas — Middle  Months 


I. 

n. 

m. 

IV. 

V. 

7-per-cent  milk . . . 

Milk  sugar 

Lime-water 

Boiled  water . 

Barley  gruel 

7  oz. 
1  " 
1  " 
12  " 
0  " 

8oz. 
1  " 
1  " 
11  " 
0  " 

9oz. 
1  " 
1  " 
10  " 
0  " 

10  oz. 

f  " 
1    " 
5    " 
4    " 

11  oz. 

1" 
1    " 
3    " 
5    " 

30  oz. 

20  oz. 

20  oz. 

20  oz. 

20  oz. 

Since  the  sugar  dissolves,  the  total  will  be  twenty 
ounces  in  each  column. 

Of  any  of  the  formulas,  25  ounces  is  made  by 
using  one  quarter  more  of  each  ingredient;  30 
ounces,  by  using  one  half  more;  35  ounces,  by  using 
three  quarters  more;  40  ounces,  by  using  twice  as 
much,  exactly  as  described  in  the  First  Series  on 
page  61. 

The  approximate  composition  of  these  formulas 
expressed  in  percentages  is  as  follows: 


Formula. 

Fat. 

Sugar. 

I^oteids. 

I 

2.50 
2.80 
3.15 
3.50 
4.00 

6.50 
6.50 
7.00 
6.00 
6.50 

1  25 

II 

1  40 

Ill 

1  55 

IV 

1  75 

V 

2  00 

FOOD  FROM  TEN  TO  FIFTEEN  MONTHS  65 

How  should  the  food  he  increased  during  this 
period? 

Beginning  with  I  of  this  Series,  which  should 
usually  follow  V  of  the  First  Series  (page  59),  the 
increase  may  generally  be  made  in  a  week  or  ten 
days  to  II ;  in  about  two  weeks  more  to  III ;  now 
more  slowly  to  IV  and  V.  When  IV  or  V  have 
been  reached,  the  same  formula  may  sometimes  be 
continued  for  three  or  four  months  with  no  other 
change  than  an  increase  in  the  quantity. 

FOOD  FEOM  TEN  TO  FIFTEEN  MONTHS THIRD  PERIOD 

What  changes  may  he  made  in  the  food  when  the 
infant  has  reached  the  age  of  ten  or  eleven  months? 

The  proteids  may  be  still  further  increased,  and 
the  sugar  and  the  lime-water  reduced  until  plain 
milk  is  given. 

How  may  this  hest  he  done? 

At  first  one  feeding  a  day  of  plain  milk  and 
barley  gruel  may  be  given ;  later,  two  feedings ;  then 
three  feedings,  etc.  Let  us  suppose  an  infant  to  be 
taking  such  a  modified  milk  as  Formula  IV  or  V 
(page  64),  six  feedings  a  day.  The  plain  milk  di- 
luted only  with  barley  gruel  would  at  first  replace  one 
of  these  feedings;  then  two,  three,  four,  etc.,  these 
changes  being  made  at  intervals  of  about  two  weeks. 
5 


66        THE  CARE  AND  FEEDING  OF  CHILDREN 

The  proportions  of  the  milk  and  barley  gruel  should 
at  first  be  about  5^  ounces  milk,  2^  ounces  barley; 
later,  6  ounces  milk,  3  ounces  barley;  still  later,  7 
ounces  milk,  2  ounces  barley,  until  finally  plain  milk 
is  given  to  drink  and  the  cereals  given  separately 
with  a  spoon.  This  is  reached  with  most  infants  at 
fourteen  or  fifteen  months;  with  many  at  twelve  or 
thirteen  months.  Other  forms  of  farinaceous  food 
may  of  course  be  used  in  the  place  of  the  barley,  and 
in  the  same  proportions. 

With  some  infants  the  addition  of  a  pinch  of 
bicarbonate  of  soda  may  be  advantageously  made  to 
each  milk-feeding  when  the  lime-water  is  omitted, 
but  with  most  this  is  unnecessary. 

If  the  infant  strongly  objects  to  the  taste  of  the 
milk  when  the  milk  sugar  has  been  omitted,  a  small 
quantity  (one  fourth  to  one  half  teaspoonful)  of 
granulated  sugar  may  for  a  time  be  added  to  each 
feeding,  then  gradually  reduced. 

GENERAL   RULES    FOB   GUIDANCE   IN   THE   USE   OF   THE 

FOEMULAS    GIVEN 

1.  These  formulas  are  not  intended  for  sick  chil- 
dren nor  for  those  suffering  from  any  marked  symp- 
toms of  indigestion.  For  such  infants  special  rules 
are  given  later. 


GENERAL  RULES  FOR  GUIDANCE  67 

2.  One  should  always  begin  with  weak  propor- 
tions; this  especially  applies  to  (1)  infants  fed  from 
birth;  (2)  those  just  weaned,  whose  food  should  be 
much  weaker  than  the  age  and  weight  would  seem  to 
indicate;  (3)  infants  whose  power  of  digestion  is 
unknown.  If  the  first  formula  tried  is  weaker  than 
the  child  can  digest,  the  food  can  be  strengthened 
every  two  days  until  it  is  found  what  the  child  is  able 
to  do.  If  the  mistake  is  made  of  making  the  food 
too  strong  at  first,  an  attack  of  indigestion  will  prob- 
ably follow. 

3.  The  gradual  increase  in  the  strength  of  the 
food  is  just  as  important  as  to  make  it  weak  in  the 
beginning.  It  is  seldom  wise  to  advance  more  rap- 
idly than  from  one  formula  to  the  next  one  in  any 
of  the  series  given.  Abruptly  increasing  the  strength 
of  the  food  is  likely  to  upset  the  digestion. 

4.  The  signs  indicating  that  the  food  should  be 
increased  are,  that  the  infant  is  not  satisfied,  not 
gaining  in  weight,  but  is  digesting  well.  One  should 
not  increase  the  food,  however,  so  long  as  the  child 
seems  perfectly  satisfied  and  is  gaining  six  to  eight 
ounces  a  week,  even  though  both  the  quantity  and 
the  strength  of  the  food  are  considerably  below  the 
average. 

5.  After  the  food  has  been  strengthened,  there  is 
sometimes  seen  a  slight  discomfort  for  a  day  or  two ; 


68    THE  CARE  AND  FEEDING  OF  CHILDREN 

but  unless  such  symptoms  are  severe  or  steadily  in- 
crease, one  should  not  go  back  to  the  weaker  for- 
mula; for  in  most  cases  the  infant  soon  becomes 
accustomed  to  the  stronger  food  and  quite  able  to 
digest  it. 

6.  In  the  early  weeks  it  is  well  first  to  in- 
crease the  strength  of  the  food,  the  next  time  the 
quantity,  then  the  strength  again,  etc.  After  the 
fourth  or  fifth  month,  the  quantity,  chiefly,  should 
be  increased. 

7.  In  the  early  weeks  an  increase  may  be  neces- 
sary every  few  days;  in  the  later  months  sometimes 
the  same  formula  may  be  continued  for  two  or  three 
months. 

8.  One  should  not  be  disturbed  in  the  first  two 
or  three  weeks,  if  the  gain  in  weight  is  slight  or  even 
if  there  is  none.  If  the  infant  does  not  lose  weight, 
if  it  is  perfectly  comfortable,  sleeps  most  of  the 
time,  and  does  not  suffer  from  any  symptoms  of 
indigestion,  such  as  colic,  vomiting,  etc.,  one  may 
be  sure  that  all  is  going  well  and  that  the  infant  is 
becoming  used  to  its  food.  With  the  demands  of 
the  child's  appetite  the  food  may  be  increased  every 
few  days,  and  soon  the  gain  in  weight  will  come  and 
will  then  be  continuous. 

9.  If  the  child  is  perfectly  comfortable  one 
should  not  be  disturbed  at  the  small  and  somewhat 


GENERAL  RULES  FOR  GUIDANCE  69 

constipated  movements  from  the  bowels  which  are 
apt  to  occur  while  the  food  is  very  weak.  If  the 
bowels  move  of  themselves  once  a  day  one  should  be 
content.  As  the  food  is  gradually  strengthened,  this 
symptom  soon  passes  off;  while,  if  an  injection  or 
medicine  is  used  to  produce  freer  movements,  the 
functions  of  the  bowels  are  soon  disturbed. 

10.  While  the  increase  of  the  food  should  always 
be  slow  and  gradual,  its  reduction,  when  any  marked 
symptoms  of  indigestion  arise,  should  be  immediate 
and  considerable.  For  a  moderate  disturbance,  one 
or  two  ounces  of  food  may  be  removed  from  each 
bottle  just  before  it  is  given,  and  this  replaced  by 
the  same  quantity  of  boiled  water.  If  the  disturb- 
ance is  severe,  the  food  should  be  diluted  at  least 
one  half,  and  at  the  same  time  the  quantity  much 
reduced. 

11.  After  the  food  has  been  reduced  on  account 
of  any  form  of  disturbance  of  digestion,  one  should 
be  careful  not  to  go  back  too  rapidly  to  the  original 
formula;  a  second  attack  of  indigestion  will  always 
occur  from  a  slighter  cause  than  the  first  one.  It  is 
surprising  how  long  a  time  is  required,  often  sev- 
eral weeks,  for  young  infants  to  recover  entirely 
from  an  attack  of  acute  indigestion,  even  though  it 
was  not  very  severe. 


70        THE  CARE  AND  FEEDING  OF  CHILDREN 


THE   ADDITION   OF   OTHER   FOODS    TO   MILK 

How  long  should  modified  milk  he  continued 
without  the  addition  of  other  food? 

This  depends  upon  circumstances;  usually,  for 
about  six  months ;  but  if  the  infant  is  thriving  satis- 
factorily the  milk  may  be  used  alone  for  ten  or  eleven 
months;  with  some  infants  who  have  especial  diflS- 
culty  in  digesting  cow's  milk,  it  is  often  advisable 
to  begin  the  use  of  other  food  at  three  or  four 
months. 

What  is  the  first  thing  to  he  used  with  milk? 
Farinaceous  food  in  some  form,   usually  as  a 
gruel. 

How  are  these  gruels  made? 

They  may  be  made  directly  from  the  grains  or 
from  some  of  the  prepared  flours  (page  114).  The 
flours  are  usually  to  be  preferred  as  beiijg  more 
simple  of  preparation. 

How  should  they  he  used  in  making  the 
food? 

They  should  be  cooked  separately,  rather  than 
with  the  milk;  when  the  food  is  mixed,  they  take 
the  place  of  a  portion  of  the  water  in  any  of  the 
formulas  given  on  pages  59  and  64. 


THE  ADDITION  OF  OTHER  FOODS  TO  MILK      71 

How  much  of  the  gruel  should  he  usedf 
If  it  is  prepared  as  recommended  on  page  113, 
it  may  make  according  to  circumstances  from  one 
sixth  to  one  half  the  total  quantity  of  food. 

Which  of  the  farinaceous  foods  are  to  he  pre- 
ferred f 

Those  most  used  are  barley,  oatmeal,  arrowroot, 
and  farina.  There  is  not  much  difference  in  their 
nutritive  value;  oatmeal  gruel  is  somewhat  more 
laxative. 

What  value  do  these  suhstances  possess  a^  infant 
foods? 

Some  of  the  starch  is  digested  and  absorbed ;  but 
their  chief  value  is  believed  to  be  that  when  added 
to  milk  they  render  the  curd  more  easily  digested 
by  preventing  it  from  coagulating  in  the  stomach  in 
large  tough  masses.  This  is  certainly  true  with  some 
infants,  but  there  are  others  who  are  not  at  all  ben- 
efited, and  not  a  few  young  infants  whose  digestion 
is  made  distinctly  worse  by  the  addition  of  farina- 
ceous food,  particularly  when  employed  in  consider- 
able quantity.  Its  use  for  all  infants  is  not  to  be 
recommended. 

What  further  additions  may  he  made  to  the  diet 
of  healthy  infants  during  the  first  year? 

Beef  juice,  the  white  of  egg,  and  orange  juice. 


72         THE  CARE  AND  FEEDING  OF  CHILDREN 


How  and  when  may  heef  juice  he  used? 

With  infants  who  are  strong  and  thriving  satis- 
factorily it  may  be  begun  at  ten  or  eleven  months; 
two  teaspoonfuls  may  be  given  daily,  diluted  with 
the  same  quantity  of  water,  fifteen  minutes  before 
the  mid-day  feeding ;  in  two  weeks  the  quantity  may 
be  doubled ;  and  in  four  weeks  six  teaspoonfuls  may 
be  given.  The  maximum  quantity  at  one  year  should 
not  be  more  than  two  or  three  tablespoonfuls. 

With  delicate  infants  who  are  pale  and  anaemic, 
beef  juice  is  more  important,  and  it  may  often  be 
wisely  begun  at  five  or  six  months  in  half  the  quan- 
tities mentioned. 

When  should  white  of  egg  he  used? 

Tinder  the  same  conditions  as  beef  juice,  particu- 
larly with  infants  who  have  difficulty  in  digesting 
the  proteids  (curd)  of  milk.  At  six  months  half  the 
white  of  one  egg  may  be  given  at  one  time,  and  soon 
after  this  the  entire  white  of  one  egg.  The  best 
manner  of  cooking  is  the  "  coddled "  egg  (see 
page  115). 

When  should  orange  juice  he  hegun? 

Usually  about  the  eleventh  or  twelfth  month;  it 
should  be  given  about  one  hour  before  the  feeding; 
two  teaspoonfuls  at  first,  then  one  tablespoonful  at 
a  time,  and  later  three  or  four  tablespoonfuls.     It 


OVERFEEDING  73 


is  particularly  useful  when  there  is  constipation.  It 
should  always  be  strained,  and  care  should  be  taken 
that  it  is  sweet  and  fresh. 

OVERFEEDING 

What  is  meant  hy  overfeeding? 

Giving  an  infant  too  much  food ;  either  too  much 
at  one  time  or  too  frequently.  Overfeeding  is  some- 
times practised  during  the  day,  but  is  chiefly  done 
at  night. 

7s  not  an  infant's  natural  desire  for  food  a 
proper  guide  as  to  the  quantity  given? 

The  appetite  of  a  perfectly  normal  infant  usu- 
ally is ;  but  overeating  is  a  habit  gradually  acquired 
and  may  continue  until  twice  as  much  food  as  is 
proper  is  taken  in  the  twenty-four  hours.  This  habit 
is  most  frequently  seen  in  infants  whose  digestion 
is  not  quite  normal ;  because  of  the  temporary  relief 
from  discomfort  experienced  by  taking  food  into  the 
stomach,  they  often  appear  to  be  hungry  the  greater 
part  of  the  time,  especially  at  night. 

What  harm  results  from  overfeeding? 

All  food  taken  in  excess  of  the  needs  of  the  body 
becomes  a  burden  to  the  child.  It  lies  in  the  stom- 
ach or  bowels  undigested,  ferments,  and  causes  wind 


74        THE  CARE  AND  FEEDING  OF  CHILDREN 

and  colic;  when  this  is  longer  continued,  serious 
disturbances  of  digestion  are  soon  produced.  The 
infant  is  restless,  fretful,  constantly  uncomfortable, 
sleeps  badly,  and  stops  gaining  and  may  even  lose 
in  weight.  Such  symptoms  may  lead  to  the  mistaken 
conclusion  that  too  little  food  is  given,  and  it  is  ac- 
cordingly increased,  when  it  should  be  diminished. 
One  of  the  results  of  long  continued  overfeeding  is 
dilatation  or  stretching  of  the  stomach. 

What  should  guide  one  as  to  the  quantity  of  food 
to  be  given  to  any  infant? 

(1)  The  size  of  the  infant's  stomach  at  the  dif- 
ferent months;  (2)  the  amount  of  milk  which  the 
healthy  nursing  infant  gets;  (3)  the  quantities  with 
which  most  children  do  best.  The  table  of  quantities 
and  intervals  of  feeding,  on  page  87,  gives  the  aver- 
age figures  derived  from  these  sources.  It  will  sel- 
dom be  wise  to  go  beyond  the  limits  there  stated. 

THE    CHANGES    IN    THE    FOOD    EEQUIRED    BY    SPECIAL 
SYMPTOMS   OE    CONDITIONS 

Why  is  it  that  an  infant  so  often  vomits  some 
of  its  food  within  a  few  moments  after  finishing  its 
bottle? 

Usually  because  the  quantity  is  too  large.  Some- 
times it  is  due  to  the  fact  that  the  food  is  taken  too 


CHANGES  REQUIRED  BY  SPECIAL  SYMPTOMS    75 

rapidly,  from  too  large  a  hole  in  the  nipple.  It  may 
be  due  to  too  tight  clothing,  or  to  moving  the  child 
about  in  such  a  way  as  to  press  upon  the  stomach. 

What  are  the  principal  causes  of,  and  the  changes 
in  the  food  required  by  habitual  vomiting,  regurgita- 
tion, or  spitting  up  of  small  quantities  of  food  be- 
tween feedings,  sometimes  repeated  many  times  a 
day? 

This  is  always  a  symptom  of  gastric  indigestion. 
In  such  conditions  the  fat  and  often  the  sugar  also 
should  be  reduced.  The  fat  may  be  reduced  by 
using,  in  the  first  series  of  formulas  for  the  early 
months  (see  page  59),  7-per-cent  milk  instead  of 
10-per-cent  milk;  or,  if  the  symptoms  are  very  se- 
vere, plain  milk  may  be  substituted  in  the  same 
formulas. 

Reduction  in  the  sugar  may  be  made  by  adding 
only  one  half  ounce  of  milk  sugar  to  each  twenty 
ounces  of  the  food ;  in  severe  cases  the  sugar  may  be 
omitted  altogether. 

In  addition  to  these  changes  it  is  often  advisable 
in  the  vomiting  cases  to  double  the  amount  of  lime- 
water — i.  e.,  use  two  ounces  to  each  twenty  ounces 
of  food. 

The  malted  foods  and  all  other  foods  containing 
much  sugar  usually  aggravate  the  symptoms. 


76         THE  CARE  AND  FEEDING  OF  CHILDREN 

The  intervals  between  meals  should  generally  be 
half  an  hour  longer,  and  sometimes  an  hour  longer, 
than  when  digestion  is  normal. 

What  are  the  causes  of,  and  food  changes  re- 
quired hy  a  constant  and  excessive  formation  of  gas 
in  the  stomach,  leading  to  distention  and  pain,  or 
eructations  {belching)  of  gas  and  often  of  a  sour, 
watery  fluid? 

This  is  often  associated  with  habitual  vomiting, 
but  it  depends  chiefly  upon  the  sugar,  which  should 
be  greatly  reduced  or  omitted  entirely. 

What  changes  should  he  made  when  there  is  ha- 
bitual colic? 

This  is  generally  due  to  an  accumulation  of  gas 
in  the  intestines  which  forms  there  because  the  pro- 
teids  (curd)  of  the  milk  are  not  digested.  They 
should  be  reduced  by  using  in  the  early  months  a 
weaker  formula — i.  e.,  instead  of  Formula  V  of  the 
First  Series,  IV  might  be  used,  or,  for  a  short  time, 
even  III.  The  proteids  may  be  reduced  in  the  mid- 
dle period  by  using  weaker  formulas.  If  we  desire 
to  reduce  the  proteids  without  reducing  the  fat,  we 
may  use  for  the  First  Series,  only  cream;  for  the 
Second  Series,  the  10-per-cent  milk. 

Another  means  of  relieving  habitual  colic  is  the 
use  of  peptonized  milk  (page  94)  ;  the  dilution  with 


CHANGES  REQUIRED  BY  SPECIAL  SYMPTOMS    77 

barley-water   instead  of  plain  water   is   sometimes 
useful. 

What  change  should  he  made  if  curds  appear  in 
the  stools  regularly  or  frequently? 

This  is  usually  associated  with  habitual  colic, 
and  has  to  be  managed  exactly  like  that  condition, 
by  the  means  just  described. 

How  should  the  milk  he  modified  for  chronic 
constipation  ? 

The  constipation  of  the  first  weeks  of  life  has  been 
already  referred  to  (page  69)  ;  it  usually  disappears 
as  the  food  is  gradually  strengthened  in  all  its  pro- 
portions. Habitual  constipation  at  a  later  period  is 
difficult  to  overcome  by  diet  alone.  It  sometimes 
depends  upon  the  fact  that  the  proteids  are  too  high, 
and  sometimes  that  the  fat  is  too  low.  Hence  it  is 
more  frequent  when  infants  are  fed  upon  plain  milk 
diluted  once  or  twice,  than  when  Y-per-cent  or  10- 
per-cent  milk  is  used,  and  diluted  to  a  greater  degree. 
In  general,  constipation  calls  for  more  cream  and 
less  milk.  In  some  cases  the  use,  in  place  of  milk 
sugar,  of  ordinary  brown  sugar,  in  half  the  quantity, 
is  of  assistance ;  or  of  some  of  the  malted  foods  (Mel- 
lin's  food,  malted  milk,  cereal  milk)  also  in  the  place 
of  milk  sugar.  In  infants  over  nine  months  old, 
orange  juice  may  be  tried. 


78    THE  CARE  AND  FEEDING  OF  CHILDREN 

What  special  modifications  are  required  hy  very 
Jiot  weather? 

During  the  warm  season  it  is  well  to  make  the 
proportion  of  fat  less  than  during  cold  weather. 
During  short  periods  of  excessive  heat  it  should  be 
much  less.  This  is  done  by  using  7-per-cent  milk 
in  place  of  10-per-cent,  in  the  First  Series  of  for- 
mulas (page  59),  or  plain  milk  in  place  of  the 
7-per-cent  milk  in  the  Second  Series  (page  64). 
At  such  times  also  the  usual  food  should  be  di- 
luted, and  water  should  be  given  freely  between  the 
feedings. 

What  changes  should  he  made  in  the  food  of  a 
child  who,  with  all  the  signs  of  good  digestion,  gains 
very  little  or  not  at  all  in  weight? 

The  quantity  of  food  should  be  increased ;  but  if 
the  child  will  not  (readily)  take  any  more  in  quan- 
tity the  strength  should  be  increased  by  the  use  of 
the  next  higher  formula. 

What  changes  are  required  for  infants  who 
habitually  sleep  badly? 

This  is  a  very  complicated  condition,  and  may 
be  due  to  indigestion  resulting  from  too  much  food, 
or  to  hunger  produced  by  too  little  food,  or  simply 
to  frequent  feeding  at  night.  Each  one  of  these 
requires  special  treatment. 


CHANGES  REQUIRED  BY  SPECIAL  SYMPTOMS    79 

What  changes  in  the  food  are  required  by  slight 
indisposition  ? 

For  slight  general  disturbances  sncli  as  dentition, 
colds,  sore  throats,  etc.,  it  is  usually  sufficient  simply 
to  dilute  the  food.  If  this  is  but  for  two  or  three 
feedings,  it  is  most  easily  done  by  replacing  with 
boiled  water  an  ounce  or  two  of  the  food  removed 
from  the  bottle  just  before  it  is  given ;  if  for  several 
days,  a  weaker  formula  should  be  used. 

What  changes  should  he  made  for  a  serious  acute 
illness  f 

For  such  attacks  as  those  of  pneumonia,  bron- 
chitis, measles,  etc.,  attended  with  fever,  the  food 
should  be  diluted  and  the  fat  reduced  as  described 
on  page  T8.  It  should  be  given  at  regular  intervals, 
rather  less  frequently  than  in  health.  Water  should 
be  given  freely  between  the  feedings.  Food  should 
not  be  forced  in  the  early  days  of  an  acute  illness, 
since  the  loss  of  appetite  usually  means  an  inability 
to  digest  much  food. 

What  immediate  changes  should  he  made  in  the 
food  when  the  child  is  talcen  with  an  acute  attach  of 
gastric  indigestion  with  repeated  vomiting,  fever, 
pain,  etc.? 

All  milk  should  be  stopped  immediately,  and 
only  boiled  water  given  for  ten  or  twelve  hours; 


80        THE  CARE  AND  FEEDING  OP  CHILDREN 

afterward  barley-water  or  whey  may  be  tried,  but 
no  milk  for  at  least  twenty-four  hours  after  the  vom- 
iting has  ceased.  When  beginning  the  modified  milk 
the  quantity  should  be  small  and  the  fat  low,  which 
may  be  secured  by  the  use  of  plain  milk  in  either 
the  First  or  Second  Series  of  formulas,  in  the  place 
of  10-per-cent  or  7-per-cent  milk.  The  proportion 
of  lime-water  may  be  doubled. 

What  changes  should  he  made  for  an  attach  of 
intestinal  indigestion  attended  hy  looseness  of  the 
bowels? 

If  this  is  not  severe  (only  two  or  three  passages 
daily)  the  fat  should  be  lowered  in  the  manner 
stated  just  above,  and  the  milk  should  be  boiled  for 
five  minutes.  If  curds  are  present  in  the  stools,  it 
may  be  still  further  diluted. 

If  the  diarrhoeal  attack  is  more  severe,  and  at- 
tended by  fever  and  foul-smelling  movements  of 
greater  frequency,  all  milk  should  be  stopped  imme- 
diately, and  the  diet  mentioned  just  above  under  the 
head  of  acute  disturbances  of  the  stomach  should  be 
employed. 

What  changes  in  the  food  should  he  made  when 
the  child  seems  to  have  very  little  appetite  and  yet 
is  not  ill? 

The  number  of  feedings  should  be  reduced,  the 


PREPARATION  OF  COW'S  MILK  AT  HOME        81 

interval  being  lengthened  by  one  hour  or  even  more. 
ISTo  greater  mistake  can  be  made  than  to  offer  food 
every  hour  or  two  to  an  infant  who  is  not  hungry. 
Such  a  course  only  prolongs  and  aggravates  the  dis- 
turbance. 

What  other  conditions  besides  the  food  greatly 
influence  the  child's  digestion? 

Proper  clothing,  warm  feet,  regular  habits,  fresh 
air,  clean  bottles,  and  food  given  at  the  proper  tem- 
perature, are  all  quite  as  important  as  the  prepara- 
tion of  the  food. 


What  articles  are  required  for  the  preparation  o 
cov/s  milk  at  home? 

Feeding-bottles,  rubber  nipples,  an  eight-ounce 
graduated  measuring  glass,  a  glass  or  agate  funnel, 
bottle  brush,  cotton,  alcohol  lamp  or,  better,  a  Bun- 
sen  gas  burner,  a  tall  quart  cup  for  warming  bottles 
of  milk,  a  pitcher  for  mixing  the  food,  a  wide-mouth 
bottle  for  boric  acid  and  one  for  bicarbonate  of  soda, 
and  a  pasteurizer.  Later,  a  double  boiler  for  cook- 
ing cereals  will  be  needed. 

What  hottles  are  to  he  preferred? 
A  cylindrical  graduated  bottle  with  a  rather  wide 
6 


82         THE  CARE  AND  FEEDING  OF  CHILDREN 

neck,  so  as  to  admit  of  easy  washing,  and  one  which 
contains  no  angles  or  corners.  A  single  size  holding 
eight  ounces  is  quite  sufficient  for  use  during  the  first 
year.  All  complicated  bottles  are  bad,  being  diffi- 
cult to  clean.  One  should  have  as  many  bottles  in 
use  as  the  child  takes  meals  a  day. 

How  should  bottles  he  cared  for? 

As  soon  as  they  are  emptied  they  should  be 
rinsed  with  cold  water  and  allowed  to  stand  filled 
with  water  to  which  a  little  bicarbonate  of  soda  has 
been  added.  Before  the  milk  is  put  into  them  they 
should  be  thoroughly  washed  with  a  bottle  brush  and 
hot  soap-suds  and  then  placed  for  twenty  minutes  in 
boiling  water. 

What  sort  of  nipples  should  he  used? 

Only  simple  straight  nipples  which  slip  over  the 
neck  of  the  bottle.  Those  with  a  rubber  or  glass 
tube  are  too  complicated  and  very  difficult  to  keep 
clean.  Nipples  made  of  black  rubber  are  to  be  pre- 
ferred. The  hole  in  the  nipple  should  not  be  so  large 
that  the  milk  will  run  in  a  stream,  but  just  large 
enough  for  it  to  drop  rapidly  when  the  bottle  with 
the  nipple  attached  is  inverted. 

How  should  nipples  he  cared  for? 

'New  nipples  should  be  boiled  for  five  minutes; 


PREPARATION  OF  COW'S  MILK  AT  HOME        83 

but  it  is  unnecessary  to  repeat  this  every  day  as  they 
soon  become  so  soft  as  to  be  almost  useless.  After 
using,  nipples  should  be  carefully  rinsed  in  cold 
water  and  kept  in  a  covered  glass  containing  a  solu- 
tion of  borax  or  boric  acid.  At  least  once  a  day  they 
should  be  turned  wrong  side  out  and  thoroughly 
washed  with  soap  and  water. 

What  sort  of  cotton  should  he  used? 

The  refined  non-absorbent  cotton  is  rather  better 
for  stoppering  bottles,  but  the  ordinary  absorbent 
cotton  will  answer  every  purpose. 

Which  is  better,  the  Bunsen  burner  or  the  alcohol 
lamp  ? 

If  there  is  gas  in  the  house,  the  Bunsen  burner 
is  greatly  to  be  preferred,  being  cheaper,  simpler, 
and  much  safer  than  the  alcohol  lamp.  If  the  lamp 
is  used,  it  should  stand  upon  a  table  covered  with  a 
plate  of  zinc  or  tin,  or  upon  a  large  tin  tray.  The 
French  pattern  of  alcohol  lamp  is  the  best. 

Give  the  directions  for  preparing  the  food  ac- 
cording to  any  of  the  above  formulas. 

The  nurse's  hands,  bottles,  tables,  and  all  utensils 
should  be  scrupulously  clean.  First  dissolve  the 
milk  sugar  in  boiling  water,  filtering  if  necessary. 
Then  add  the  milk  and  cream  and  lime-water,  mix- 


84   THE  CARE  AND  FEEDING  OF  CHILDREN 

ing  the  whole  in  a  pitcher.  A  sufficient  quantity  of 
food  for  twenty-four  hours  is  always  to  be  prepared 
at  one  time.  This  is  then  divided  into  the  number 
of  feedings  required  for  the  day,  each  feeding  being 
put  in  a  separate  botttle,  and  the  bottle  stoppered 
with  cotton.  The  bottles  should  then  be  cooled  rap- 
idly by  standing,  first  in  tepid  then  in  cold  water, 
and  afterward  placed  in  an  ice  chest.  If  the  milk 
is  to  be  pasteurized  or  sterilized,  this  should  precede 
the  cooling. 

DIEECTIONS    FOE   FEEDING   INFANTS 

How  should  the  bottle  he  'prepared  at  feeding 
time? 

It  should  be  taken  from  the  ice  chest,  and 
warmed  by  standing  in  warm  water  which  is  deep 
enough  to  cover  the  milk  in  the  bottle;  it  should 
then  be  thoroughly  shaken  and  the  nipple  adjusted; 
the  nurse  should  see  that  the  hole  in  the  nipple  is 
not  too  large  nor  too  small. 

How  may  the  temperature  of  the  milk  he  tested  f 
!N"ever  by  putting  the  nipple  in  the  nurse's 
mouth.  Before  adjusting  the  nipple,  a  teaspoonful 
may  be  poured  from  the  bottle  and  tasted,  or  a  few 
drops  may  be  poured  through  the  nipple  upon  the 
inner   surface   of  the  wrist,   where   it   should   feel 


DIRECTIONS  FOR  FEEDING  INFANTS  86 

quite  warm  but  never  hot;  or  a  thermometer  may 
be  placed  in  the  water  in  which  the  bottle  stands. 
A  dairy  thermometer  should  be  used,  and  the  tem- 
perature of  the  water  should  be  between  98°  and 
105°  F. 

What  is  a  simple  contrivance  for  keeping  the 
milk  warm  during  feeding? 

A  small  flannel  bag  with  a  draw  string  may  be 
slipped  over  the  bottle. 

In  what  position  should  an  infant  take  its 
bottle? 

For  the  first  two  or  three  months  it  is  better, 
except  at  night,  when  it  may  be  undesirable  to  take 
the  infant  from  its  crib,  that  it  be  held  on  the  nurse's 
arm  during  the  feeding;  later  it  may  lie  on  its  side 
in  the  crib  provided  the  bottle  is  held  by  the  nurse 
until  it  has  been  emptied ;  otherwise  a  young  infant 
readily  falls  into  the  bad  habit  of  alternately  sucking 
and  sleeping,  and  often  will  be  an  hour  or  more  over 
its  bottle. 

How  much  time  should  he  allowed  for  one  feed- 
ing? 

iN'ever  more  than  twenty  minutes.  The  bottle 
should  then  be  taken  away  and  not  given  until  the 
next  feeding  time.     Under  no  circumstances  should 


86        THE  CARE  AND  FEEDING  OP  CHILDREN 

an  infant  form  the  habit  of  sleeping  with  the  nipple 
in  its  mouth.  A  sleepy  infant  should  be  kept  awake 
by  gentle  shaking  until  the  food  is  taken,  or  the  bot- 
tle should  be  removed  altogether. 

Should  an  infant  be  played  with  soon  after  feed- 
ing? 

On  no  account;  such  a  thing  frequently  causes 
vomiting  and  sometimes  indigestion.  After  every 
feeding  the  infant  should  be  allowed  to  lie  quietly  in 
its  crib,  and  disturbed  as  little  as  possible. 

INTEBVALS    OF    FEEDING 

How  often  should  a  hahy  he  fed  during  the  first 
month  ? 

Every  two  hours  during  the  day  and  twice  dur- 
ing the  night,  or  ten  feedings  during  the  twenty-four 
hours. 

At  what  age  may  the  interval  he  made  two  and  a 
half  hours? 

Usually  at  five  weeks. 

When  may  it  he  increased  to  three  hours? 
Usually  at  two  and  a  half  months. 

Why  should  not  a  child  he  fed  more  frequently? 
It  takes  the  stomach  nearly  two  hours  to  digest  a 


INTERVALS  OF  FEEDING 


87 


meal  at  two  months,  and  about  two  and  a  half  hours 
at  five  or  six  months,  and  if  the  meals  are  too  near 
together  the  second  one  is  given  before  the  first  has 
been  digested  and  vomiting  and  indigestion  result. 
The  meals  should  be  far  enough  apart  to  give  the 
stomach  a  little  time  for  rest  just  before  each 
feeding. 

Schedule  for  feeding  Healthy  Infants  during  the 
First  Year 


ASB. 

Inter- 
val be- 
tween 
meals, 
by  day. 

Night 
feed- 
ings (10 
P.M.  to 
7  A.  M.). 

No.  of 
feed- 
ings in 

hours. 

Quantity 
for  one 
feeding. 

Quantity 
for  24 
hours. 

2d  to  7th  day 

Houn. 

2 
2 
2 

2i 
3 
3 
4 

2 
2 

1 
1 
1 
0 
0 

10 
10 
10 
8 
7 
6 
5 

OoDcet. 

1-U 
lf-3 
2i-3i 
3  -6 
4-6 
5  -7i 
7  -9 

Onocet. 
10-15 

2d  and  3d  weeks 

4th  and  5th  weeks 

6th  week  to  3d  month . 

3d  to  5th  month 

5th  to  9th  month 

9th  to  12th  month 

15-30 
25-35 
24.40 
28-42 
30-45 
35-45 

This  schedule  gives  the  averages  for  healthy  chil- 
dren. The  smaller  quantities  are  those  required  by 
small  children  whose  digestion  is  not  very  vigorous. 
The  larger  quantities  are  those  required  by  large 
children  with  strong  digestion;  in  very  few  cases 
will  it  be  advisable  to  go  above  these  figures. 

The  interval  is  reckoned  from  the  beginning  of 
one  feeding  to  the  beginning  of  the  next  one. 


88        THE  CARE  AND  FEEDING  OF  CHILDREN 

When  should  the  interval  between  the  feedings 
he  lengthened? 

When  there  is  gastric  indigestion  as  shown  by 
habitual  vomiting  or  the  regurgitation  of  food  long 
after  the  bottle  is  finished ;  also  when  the  appetite  is 
very  poor  so  that  the  infant  regularly  leaves  some  of 
its  food. 

When  should  the  interval  between  the  feedings 
he  shortened? 

This  is  done  much  too  frequently;  it  is  rarely 
advisable  to  feed  any  infant  except  one  seriously  ill, 
oftener  than  the  time  put  down  in  the  schedule. 

EEGULAEITY   IN    FEEDING 

How  can  a  hahy  he  taught  to  he  regular  in  its 
habits  of  eating  and  sleeping? 

By  always  feeding  at  regular  intervals  and  put- 
ting to  sleep  at  exactly  the  same  time  every  day  and 
evening. 

When  should  regular  training  he  begun? 
During  the  first  week  of  life. 

Should  a  baby  be  wahened  to  he  nursed  or  fed  if 
sleeping  quietly? 

Yes,  for  a  few  days.  This  will  not  be  re- 
quired  long,   for   with   regular   feeding   an   infant 


STERILIZED  MILK 


soon   wakes    regularly   for    its   meal,    almost    upon 
the  minute. 

Should  regularity  in  feeding  he  hept  up  at  night 
as  well  as  during  the  day? 

Only  up  to  nine  or  ten  o'clock;  after  that  time  a 
baby  should  be  allowed  to  sleep  as  long  as  it  will. 

At  what  age  may  a  well  hahy  go  without  food 
from  10  p.  M.  to  Q  or  7  a.  m.  ? 

Usually  at  four  months,  and  always  at  five  or  six 
months.  !Night  feeding  is  one  of  the  most  frequent 
causes  of  wakefulness  and  disturbed  sleep. 

STEEILIZED    MILK 

What  is  meant  hy  sterilizing  milk? 
Heating   milk   for    the    purpose    of   destroying 
germs. 

Does  all  cows'  milk  contain  germs? 

Yes;  even  when  handled  most  carefully,  milk 
contains  many  germs;  but  when  carelessly  handled, 
and  in  summer,  the  number  is  enormous.  While 
most  of  these  are  harmless  or  cause  only  the  souring 
of  milk,  others  are  occasionally  present  which  may 
produce  serious  diseases  such  as  typhoid  fever,  diph- 
theria, scarlet  fever,  cholera,  tuberculosis,  and  many 
forms  of  diarrhoea. 


90    THE  CARE  AND  FEEDING  OF  CHILDREN 

Under  what  circumstances  is  it  necessary  to  ster- 
ilize milk? 

1.  In  warm  weather  when  it  cannot  be  obtained 
fresh;  hence  always  in  cities  during  the  summer. 

2.  When  one  cannot  be  certain  that  the  cows 
are  healthy,  or  that  the  milk  has  been  carefully 
handled. 

3.  When  the  niilk  is  to  be  kept  for  any  consider- 
able time  (i.  e.,  over  twenty-four  hours),  especially 
if  no  ice  can  be  had. 

4.  During  epidemics  of  typhoid  fever,  scarlet 
fever,  diphtheria,  or  any  form  of  diarrhoeal  disease. 

What  are  the  two  methods  of  heating  milk? 

The  first  is  known  as  sterilizing,  where  the  milk 
is  heated  to  212°  F.  for  one  hour  or  one  hour  and  a 
half ;  the  second  is  known  as  pasteurizing,  where  the 
milk  is  heated  to  155°  or  170°  F.  for  thirty  minutes. 
A  temperature  of  155°  F.  continued  for  thirty  min- 
utes is  sufficient  to  kill  the  germs  of  the  diseases 
above  referred  to. 

Will  milk  which  has  been  thu^  treated  keep  in- 
definitely ? 

IS^o;  for  although  all  the  living  germs  may  be 
killed,  there  are  many  undeveloped  germs,  or  spores, 
which  are  not  destroyed,  and  which  soon  grow  into 
living  germs.     Milk  heated  to  212°  F.  for  an  hour 


STERILIZED  MILK  91 

will  keep  upon  ice  for  two  or  three  weeks;   that 
heated  to  155°  F.  for  two  or  three  days. 

Is  milk  which  has  been  sterilized  always  a  safe 
food? 

'No ;  for  the  reason  that  the  milk  may  be  so  old, 
so  dirty,  and  so  contaminated  before  sterilizing  that 
it  may  be  still  unfit  for  food,  though  it  contains  no 
living  germs. 

Is  cow's  milh  rendered  more  digestible  by  being 
heated  in  this  way? 

Sterilizing  milk  does  not  improve  the  digestibil- 
ity of  milk  but  rather  the  contrary.  Sterilized  milk 
should  be  modified  for  infant  feeding  in  the  same 
way  as  milk  which  has  not  been  heated. 

Is  milk  in  any  way  injured  by  heating  to  212° 
F.  for  an  hour? 

There  is  abundant  evidence  that  milk  is  ren- 
dered less  digestible  by  such  heating;  also  that  it  is 
more  constipating,  and  that,  for  some  children  its 
nutritive  properties  are  interfered  with,  so  that  it 
may  cause  scurvy;  this,  however,  is  not  seen  unless 
it  is  continued  as  the  sole  food  for  a  long  period. 
These  objections  are  of  so  much  importance  that  this 
plan  of  heating  milk  is  not  to  be  recommended  for 
general  use. 


92        THE  CARE  AND  FEEDING  OF  CHILDREN 

When  is  it  advantageous  to  heat  milk  to  212°  FJ 
For  use  upon  long  journeys,  such  as  crossing  the 
ocean.     Milk  should  then  be  heated  for  one  hour 
upon  two  successive  days,  without  removing  the  cot- 
ton stoppers  from  the  bottles. 

7s  milk  in  any  way  injured  hy  heating  to  155°  F. 
for  thirty  minutes? 

This  point  is  not  yet  definitely  settled.  Such 
heating  does  not  affect  the  taste  of  milk  and  does 
render  it  more  constipating.  The  unfavourable 
effects,  if  there  are  any,  are  so  slight  that  they  need 
not  deter  one  from  the  use  of  pasteurized  milk,  even 
for  long  periods.  The  preference,  however,  should 
always  be  given  to  milk  which  is  so  clean  and  so  fresh 
as  not  to  require  any  heating. 

How  should  milk  he  pasteurized? 

A  convenient  form  of  apparatus  is  that  known 
as  Freeman's  pasteurizer ;  *  another  is  the  Walker- 
Gordon  pasteurizer.^ 

Eow  should  milk  he  cooled  after  pasteurizing? 
Always  by  placing  the  bottles  in  cold  water,  so 

^  This  can  be  obtained  at  411  "West  Fifty-ninth  Street,  New 
York,  vpith  full  directions  ;  a  tin  one,  at  a  cost  of  $3,  and  a  cop- 
per one,  which  is  much  more  durable,  for  $6. 

'  Obtained  from  any  of  the  Walker  -  Gordon  milk  labora- 
tories. 


MODIFIED  MILK  OF  THE  MILK  LABORATORIES   93 

as  to  cool  them  rapidly ;  never  by  letting  them  stand 
at  the  temperature  of  the  room,  or  by  placing  them, 
when  warm,  in  an  ice  box. 

Why  is  this  precaution  necessary? 

Cooling  in  the  air  or  in  an  ice  box  requires  from 
two  to  four  hours,  and  during  that  time  a  great  many 
of  the  undeveloped  germs  may  mature  and  greatly 
injure  the  keeping  properties  of  the  milk.  In  the 
cold  water,  milk  can  be  cooled  in  from  ten  to  twenty 
minutes  if  the  water  is  frequently  changed,  or  if  ice 
is  added  to  the  water. 

MODIFIED    MILK    OF    THE    MILK    LABOEATOEIES 

What  is  "  modified  milk "  of  the  milk  labora- 
tories 9 

It  is  milk  containing  definite  proportions  of  the 
fat,  sugar,  proteids,  etc.,  put  up  usually  according 
to  the  prescription  of  a  physician,  who  indicates  how 
much  of  the  different  elements  he  desires.  The  most 
reliable  are  the  laboratories  of  the  Walker-Gordon 
Company,  which  has  branches  in  many  of  the  large 
cities  of  the  United  States. 

This  is  an  excellent  method  of  having  milk 
prepared,  since  it  can  be  done  with  greater  care 
and  cleanliness  than  are  possible  in  most  homes. 
It  is  besides  a  great  convenience  if  circumstances 


94        THE  CARE  AND  FEEDING  OP  CHILDREN 

make  it  impossible  to  prepare  the  milk  properly  at 
home. 

The  laboratory  should  be  used  for  infant  feed- 
ing only  by  one  who  is  somewhat  familiar  with  this 
method  of  ordering  milk. 

PEPTONIZED   MILK 

What  is  peptonized  milhf 

Milk  in  which  the  proteids  (curd)  have  been  par- 
tially digested. 

How  is  this  accomplished? 

By  the  action  of  a  peptonizing  powder  which  is 
composed  of  a  digestive  agent  known  as  the  extract- 
um  pancreatis  and  bicarbonate  of  soda,  which  is 
added  to  the  plain  or  diluted  milk.  This  is  sold  in 
tubes  or  in  tablets,  and  it  is  the  active  ingredient 
of  the  peptogenic  milk  powder. 

Describe  the  process. 

The  plain  or  modified  milk  is  placed  in  a  clean 
glass  jar  or  bottle,  and  the  peptonizing  powder, 
which  is  first  rubbed  up  with  a  tablespoonful  of  the 
milk,  is  added  and  the  bottle  shaken.  The  bottle  is 
then  placed  in  a  large  pitcher  or  basin  containing 
water  kept  at  the  temperature  of  about  110°  F.,  or  as 
warm  as  the  hand  can  bear  comfortably,  and  left  for 


PEPTONIZED  MILK  95 

ten  to  twenty  minutes  if  the  milk  is  to  be  partially 
peptonized;  for  two  hours  if  it  is  to  be  completely 
peptonized. 

What  taste  has  partially  peptonized  milJc? 

None,  if  it  is  continued  for  only  ten  minutes, 
but  at  the  end  of  twenty  minutes  it  begins  to  be 
bitter,  when  the  process  of  digestion  has  gone 
further. 

How  is  the  hitter  taste  avoided  in  partially  pep- 
tonized milk? 

At  the  end  of  ten  or  fifteen  minutes  the  milk  may 
be  placed  in  a  saucepan  and  quickly  raised  to  boiling 
point;  this  kills  the  ferment,  so  that  the  milk  will 
not  become  bitter  when  warmed  a  second  time.  Or, 
the  milk  may  be  rapidly  cooled  by  placing  the  bottles 
first  in  cool  and  then  in  ice  water;  in  this  way  the 
ferment  is  not  destroyed,  and  the  milk  may  become 
bitter  when  warmed  for  feeding. 

Should  the  whole  day's  supply  he  peptonized  ai 
once  J  or  each  hottle  separately  just  he  fore  the  feed- 
ing? 

Either  plan  may  be  followed.  If  the  former,  it 
is  better  to  raise  the  milk  to  boiling  point  after  pep- 
tonizing; if  the  latter,  it  should  not  be  peptonized 
more  than  ten  minutes,  for  it  will  continue  to  pep- 
tonize while  it  is  being  taken  by  the  child. 


96        THE  CARE  AND  FEEDING  OF  CHILDREN 

Is  not  the  bitter  taste  of  completely  peptonized 
milk  a  great  obstacle  to  its  use  ? 

Not  in  the  case  of  young  infants;  one  under 
four  or  five  months  old  will  usually  take  it  with- 
out any  objection  after  two  or  three  feedings;  but 
it  cannot  often  be  used  for  those  who  are  much 
older. 

How  much  of  the  peptonizing  powder  should  be 
used? 

There  are  required  for  one  pint  of  plain  milk, 
five  grains  of  the  extractum  pancreatis  and  fifteen 
grains  of  bicarbonate  of  soda.  This  quantity  is  usu- 
ally put  up  in  a  single  tube  or  tablet.  In  the  formu- 
las previously  given,  less  than  this  will  be  required ; 
for  the  weaker  formulas,  one  half  or  one  third 
of  the  powder  mentioned  will  be  suflficient  for  one 
pint  of  food.  For  a  single  feeding  of  four  ounces, 
one  may  use  one  eighth  of  a  tube  with  a  weak 
formula,  or  one  sixth  of  a  tube  with  a  stronger 
formula. 

What  are  the  advantages  of  peptonized  milkf 
Partially  peptonized  milk  is  useful  for  young  in- 
fants who  have  great  difficulty  in  digesting  the  curd 
of  milk,  sometimes  even  when  diluted  as  already  de- 
scribed; completely  peptonized  milk,  during  acute 
attacks  of  indigestion. 


FEEDING  DURING  THE  SECOND  YEAR  97 

For  how  long  a  period  may  the  use  of  peptonized 
milk  he  continued? 

Completely  peptonized  milk  may  be  used  for  a 
few  days,  or  at  most  a  few  weeks;  partially  pepto- 
nized milk  may  be  used  for  two  or  three  months,  but 
not  indefinitely;  it  should  be  left  off  gradually  by 
shortening  the  time  of  peptonizing,  and  lessening  the 
amount  of  the  powder  used. 


FEEDING  DUEING  THE  SECOND  YEAK 

How  many  meals  are  required  during  the  second 
year,  and  what  are  the  most  convenient  hours? 

It  is  usually  better  to  continue  five  meals 
throughout  the  second  year,  the  hours  being  6.30 
and  10  A.  M.  and  2,  6,  and  10  p.  m.  Some  children 
will  sleep  from  6  p.  m  to  6  a.  m.  without  waking,  but 
unless  there  is  a  feeding  at  10  p.  m.  children  are  apt 
to  wake  very  early  in  the  morning. 

Should  each  feeding  he  prepared  at  the  time  it  is 
given,  or  all  feedings  at  one  time,  as  during  the  first 
year? 

During  the  second  and  third  years  it  is  better  to 
prepare  the  milk  for  the  entire  day  at  one  time.  If 
it  is  to  be  modified  by  adding  cream,  water,  etc.,  it  is 
done  exactly  as  during  the  first  year. 
7 


98   THE  CARE  AND  FEEDING  OP  CHILDREN 

Later,  when  only  plain  milk  is  used,  the  quanti- 
ties needed  for  the  different  feedings  should  be  put 
into  one  or  into  two  bottles,  which  then  may  be  pas- 
teurized or  not  as  may  be  necessary.  In  this  way 
the  different  feedings  are  kept  separate,  and  the 
day's  supply  of  milk  is  not  disturbed  every  time  the 
child  is  fed,  as  otherwise  is  unavoidable.  The  food 
should  be  prepared  as  soon  as  possible  after  the  daily 
milk  supply  is  delivered  in  the  morning. 

Give  a  proper  diet  for  an  average  child  from  the 
twelfth  to  the  fifteenth  month. 

First  meal :  A  bottle  containing  ten  ounces,  com- 
posed of  milk,  seven  ounces,  and  three  ounces  of 
wheat,  oatmeal,  or  barley  gruel.  If  the  milk  is  not 
up  to  the  average  in  richness,  one  ounce  of  cream 
and  six  ounces  of  milk  may  be  used.  A  pinch  of 
salt  and  half  a  teaspoonful  of  granulated  sugar  may 
be  added. 

Second  meal:  Same  as  the  first. 

Third  meal:  Beef  juice,  one  or  two  ounces, 
three  times  a  week;  an  egg  (coddled  or  soft  boiled) 
twice  a  week;  chicken  or  mutton  broth,  four  to 
six  ounces  twice  a  week;  and  a  bottle  contain- 
ing half  the  amount  given  at  the  first  meal.  A 
small  thin  piece  of  crisp  toast  may  be  given  with 
the  broth. 


FEEDING  DURING  THE  SECOND  YEAR  99 

Fourth  meal:  Same  as  the  first. 
Fifth  meal:  Same  as  the  first. 

What  fruit  may  he  given  at  this  period? 

Only  fruit  juices,  of  which  orange  juice  is  the 
best;  next  to  this  the  juice  of  fresh  ripe  peaches, 
apricots,  or  strawberries.  All  these  should  be 
strained  very  carefully  through  muslin  to  make  sure 
that  the  child  gets  none  of  the  pulp  or  seeds,  both  of 
which  may  cause  serious  disturbance.  Of  the  orange 
or  peach  juice,  from  one  to  four  tablespoonfuls  may 
be  allowed  at  one  time;  of  the  others  about  half  the 
quantity.  The  fruit  juice  is  best  given  one  hour 
before  the  second  feeding. 

When  should  the  bottle  as  a  method  of  feeding  he 
given  up  f 

Most  children  can  and  should  be  taught  to  take 
their  food  from  the  cup  or  spoon  by  the  time  they  are 
thirteen  or  fourteen  months  old.  The  bottle  may  be 
allowed  at  the  night  feeding  for  a  few  months  longer, 
bat  its  use  during  the  day  should  not  be  permitted 
after  the  age  mentioned  (see  page  44). 

Give  a  proper  diet  for  an  aA)erage  chUd  from  the 
fifteenth  to  the  twentieth  month. 

First  meal :  Ten  to  twelve  ounces  of  plain  milk, 
warmed,  taken  from  a  cup. 


100      THE  CARE  AND  FEEDING  OF  CHILDREN 

Second  meal:  Two  tablespoonfuls  of  oatmeal, 
hominy,  wheaten  grits,  or  some  other  cereal,  thor- 
oughly cooked  from  three  to  four  hours  and  strained, 
with  one  or  two  ounces  of  thin  cream,  half  a  tea- 
spoonful  of  sugar  and  salt;  plain  milk,  from  six  to 
eight  ounces. 

Third  meal :  Besides  the  articles  allowed  for  this 
feeding  at  fifteen  months  there  may  be  given  boiled 
rice  (cooked  three  hours),  usually  with  beef  juice; 
stale  bread,  zwieback,  or  the  Huntley  and  Palmer 
breakfast  biscuits;  if  the  molar  teeth  are  through, 
rare  scraped  meat,  such  as  beefsteak  or  mutton-chop, 
at  first  only  a  teaspoonful  at  a  time;  prune  pulp, 
one  or  two  tablespoonfuls;  plain  milk,  from  four  to 
six  ounces. 

Fourth  meal:  Farina  and  milk,  from  ten  to 
twelve  ounces  in  all,  alternating  with  arrowroot  or 
granum  and  milk,  or  stale  bread  and  milk. 

Fifth  meal:  From  ten  to  twelve  ounces  of  plain 
milk  from  a  bottle. 

Orange  juice  and  other  fruit  juices  may  be  given 
as  during  the  early  part  of  the  second  year,  and  in 
somewhat  larger  quantity. 

Cannot  most  children  take  plain  milk  before 
they  are  fifteen  months  old? 

Many  can  but  many  cannot,  or  at  least  they  do 


FEEDING  DURING  THE  SECOND  YEAR         101 

much  better  when  the  milk  is  modified  by  the  addi- 
tion of  cream  and  water  or  diluted  with  gruels. 

Give  a  proper  diet  for  an  average  child  from  the 
twentieth  to  the  twenty-fourth  month. 

First  meal:  Plain  milk,  from  ten  to  twelve 
ounces. 

Second  meal :  The  same  cereals  as  during  the  pre- 
ceding four  months,  except  that  they  need  no  longer 
be  strained,  but  they  should  still  be  very  thoroughly 
cooked ;  plain  milk,  from  six  to  eight  ounces ;  piece 
of  stale  bread. 

Third  meal:  Eare  meat  pulp  (steak,  chop,  or 
roast  beef),  from  one  teaspoonful  to  one  tablespoon- 
ful,  well  salted,  and  four  ounces  of  chicken  or  mut- 
ton broth ;  on  alternate  days  from  two  to  four  ounces 
of  beef  juice,  or  a  soft  egg  mixed  with  bread  crumbs 
or  with  one  tablespoonful  of  well-cooked  rice  jelly; 
stale  bread,  without  butter;  and  fruit;  only  water 
to  drink. 

Fourth  meal:  Farina,  granum,  barley,  and  milk, 
from  ten  to  twelve  ounces  in  all. 

Fifth  meal:  From  ten  to  twelve  ounces  plain 
milk. 

What  fruits  may  he  given  at  this  period? 
If  the   child   has   a   feeble   digestion,   only   the 
fruit  juices  previously  allowed ;  strong  children  may 


103   THE  CARE  AND  FEEDING  OF  CHILDREN 

have  in  addition  prune  pulp,  baked  apple,  and  apple- 
sauce. The  prune  pulp  is  prepared  by  stewing  the 
dried  prunes  without  sugar  until  they  are  very  soft, 
and  removing  all  the  skin  by  putting  the  fruit 
through  a  strainer;  of  this  from  one  to  two  table- 
spoonfuls  may  be  given  at  one  time.  The  baked 
apple  should  be  given  plain,  and  the  apple-sauce 
should  have  very  little  sugar. 

How  and  when  should  water  he  given? 

Throughout  the  second  year  water  should  be 
given  freely  between  the  feedings,  especially  in 
warm  weather;  from  one  to  three  ounces  may  be 
given  at  one  time,  either  from  a  spoon,  a  glass,  or  a 
bottle.  The  water  should  be  boiled  daily  and  then 
cooled.  It  should  not  be  allowed  to  stand  in  the 
room,  but  fresh  water  should  be  put  into  the  bottle 
each  time. 


THE  FEEDING  OF  OLDEK  CHILDKEN 

How  many  meals  are  required  during  the  third 
year? 

Usually  but  four,  the  10  p.  m.  feeding  being 
omitted  when  the  child  is  two  years  old;  otherwise 
the  hours  may  be  about  the  same  as  during  the  sec- 
ond year. 


THE  FEEDING  OF  OLDER  CHILDREN  103 

Give  a  proper  diet  for  an  average  child  during 
the  third  year. 

Three  quarters  of  an  hour  before  breakfast  the 
juice  of  an  orange. 

First  meal:  Two  tablespoonfuls  of  a  well-cooked 
cereal  with  cream,  a  little  sugar,  and  salt;  stale  or 
dried  bread  and  butter;  glass  of  warm  milk;  soft 
egg  three  times  a  week. 

Second  meal:  Glass  of  warm  milk,  or  a  cup  of 
chicken  or  mutton  broth,  with  a  slice  of  stale  or  dried 
bread,  a  piece  of  unsweetened  zwieback,  or  a  Hunt- 
ley and  Palmer  breakfast  biscuit. 

Third  meal:  Broth  (when  not  given  at  second 
meal)  ;  meat — steak,  chop,  roast  beef,  roast  lamb — 
or  white  meat  of  chicken,  all  scraped  or  very  finely 
cut;  potato,  baked  or  boiled  and  mashed,  or  rice,  or 
macaroni  stewed  very  soft  with  milk;  asparagus,  or 
fresh  peas,  or  string  beans,  or  spinach,  or  stewed 
celery,  all  thoroughly  cooked  and  mashed;  bread 
and  butter;  junket,  or  plain  custard  twice  a  week; 
on  other  days  prunes  or  baked  apple  or  apple- 
sauce. 

Fourth  meal:  From  ten  to  fourteen  ounces  of 
warm  milk,  with  bread,  farina,  arrowroot,  barley, 
com  starch,  or  granum,  and  milk,  or  milk  toast. 


104      THE  CABE  AND  FEEDING  OF  CHILDREN 

ASTIOLES   ALLOWED    FEOM    THE    THIED    TO    THE 
SEVENTH    YEAR 

Milk. — This  should  be  the  basis  of  the  diet ;  most 
children  require  about  one  quart  daily.  This  usually 
needs  no  modification,  but  if  the  curd  is  somewhat 
difficult  of  digestion,  it  may  be  prepared  by  adding 
to  six  ounces  of  milk,  one  ounce  of  cream,  and 
three  ounces  of  water.  The  milk  should  be  given 
warm. 

Cream. — This  is  of  great  value,  especially  when 
there  is  a  tendency  to  constipation.  From  two  to  four 
ounces  may  be  given  daily ;  but  it  is  essential  that  it 
be  fresh.  It  may  be  used  upon  cereals,  upon  potato, 
in  broths,  and  mixed  with  milk.  In  many  cases  it 
is  advisable  to  withhold  milk  and  give  only  cream. 
Cream  should  be  omitted  if  its  use  is  followed  by 
coating  of  the  tongue,  foul  breath,  looseness  of  the 
bowels,  or  other  signs  of  indigestion. 

Eggs. — They  should  be  fresh,  soft-boiled,  poached, 
or  coddled,  but  never  fried.  Some  children  tire 
readily  of  eggs,  even  though  the  manner  of  cooking 
is  varied.  Others  will  take  an  egg  twice  a  day  for 
an  indefinite  period  with  relish  and  benefit. 

Meats. — Some  form  of  meat  should  be  given  once 
a  day.     The  best  forms  are  beefsteak,  mutton-chop, 


ARTICLES  ALLOWED,  THIRD  TO  SEVENTH  YEAR   105 

and  roast  beef  or  lamb ;  next  to  these  the  white  meat 
of  chicken,  or  fresh  fish,  which  should  be  boiled  or 
broiled.    Beef  and  mutton  should  be  given  rare. 

Vegetables. — Potato  may  be  given  once  a  day, 
preferably  baked,  with  the  addition  of  cream  or  beef 
juice  rather  than  butter.  Of  the  green  vegetables 
the  best  are  asparagus  tops,  spinach,  stewed  celery, 
small  carrots,  string  beans,  fresh  peas,  and  squash. 
Young  beets  may  be  used  if  thoroughly  cooked.  One 
of  these  vegetables  should  be  given  daily,  always  well 
cooked  and  mashed. 

Cereals. — Kearly  all  these  may  be  used,  oatmeal, 
wheaten  grits,  hominy,  rice,  farina,  and  arrowroot. 
The  most  important  part  of  the  preparation  is  thor- 
ough cooking.  If  the  grains  are  used,  cereals  should 
be  cooked  at  least  three  hours,  after  having  been 
previously  soaked  several  hours;  if  the  prepared 
(steamed)  oats  or  wheat,  they  should  be  cooked  at 
least  one  hour  and  a  half;  the  prepared  flours,  at 
least  twenty  minutes.  They  should  always  be  well 
salted,  and  given  with  milk  or  cream,  but  with  little 
or  no  sugar. 

Broths  and  Soups. — The  meat  broths  are  prefer- 
able to  the  vegetable  broths.  IN^early  all  varieties 
may  be  given.  Plain  broths  are  not  very  nutritious, 
but  when  thickened  with  arrowroot  or  cornstarch, 


106       THE  CARE  AND  FEEDING  OF  CHILDREN 

and  when  cream  or  milk  is  added,  they  are  very 
palatable,  and  at  the  same  time  a  valuable  addition 
to  the  diet.  Beef  juice  may  be  used  as  directed  for 
the  second  year. 

Bread  and  Crackers. — In  some  form  these  may 
be  given  with  nearly  every  meal,  with  very  little 
butter  until  the  third  year,  as  for  young  children 
cream  is  usually  a  better  form  of  fat.  All  varieties 
of  bread  may  be  allowed  when  stale;  also  dried 
bread,  zwieback,  and  oatmeal,  Graham,  or  gluten 
crackers,  or  Huntley  and  Palmer  breakfast  biscuits. 

Desserts. — The  only  ones  that  should  be  allowed 
up  to  the  sixth  year  are  junket,  plain  custard,  rice 
pudding  without  raisins,  and,  not  oftener  than  once 
a  week,  ice-cream.  Of  the  last  three,  the  quantity 
given  should  be  very  moderate. 

Fruits. — They  are  an  important  part  of  a  child's 
diet,  and  should  be  given  in  some  form  every  day. 
Oranges,  baked  apple,  and  stewed  prunes  are  the 
most  to  be  depended  upon.  Raw  apples  in  most 
cases  should  not  be  given.  Peaches,  pears,  and 
grapes  (with  seeds  removed)  may  be  given  when 
thoroughly  ripe  and  fresh,  but  only  in  moderate 
quantity.  Special  care  should  be  exercised  in  the 
use  of  fruits  in  very  hot  weather,  and  in  cities  where 
they  may  not  always  be  fresh.    Berries  and  cherries 


ARTICLES  FORBIDDEN  107 

are  best  deferred  until  children  are  five  or  six  years 
old,  and  even  then  should  be  given  very  sparingly. 

ARTICLES    FOEBIDDEN 

The  following  articles  of  food  are  improper  for  a 
healthy  child  under  four  years  of  age  in  all  circum- 
stances. N^early  all  of  them  should  be  prohibited  in 
the  case  of  children  under  seven  years : 

Meats. — Ham,  sausage,  pork  in  all  forms,  salt 
fish,  corned  beef,  dried  beef,  goose,  duck,  game,  kid- 
ney, liver  and  bacon,  meat  stews,  and  dressings  from 
roasted  meats. 

Vegetables. — Those  especially  objectionable  are 
cucumbers,  radishes,  green  corn,  and  raw  tomatoes. 
Nearly  as  bad  are  cabbage,  cauliflower,  and  raw  cel- 
ery or  onions.  Stewed  or  fried  potatoes,  egg  plant, 
and  cooked  tomatoes  are  not  to  be  recommended. 

Bread  and  Cake. — All  hot  bread,  biscuits,  or 
rolls;  buckwheat  and  all  other  griddle  cakes;  all 
sweet  cakes,  particularly  those  containing  dried 
fruits  and  those  heavily  frosted. 

Desserts. — All  nuts,  candies,  dried  fruits;  all 
canned  or  preserved  fruits ;  pies,  tarts,  and  pastry  of 
every  description. 


108       THE  CARE  AND  FEEDING  OP  CHILDREN 

Drinks. — Tea,  coffee,  wine,  beer,  soda-water,  and 
cider. 

Fruits. — ^Bananas;  all  fruits  out  of  season;  all 
stale  fruits,  particularly  in  cities  and  during  the 
summer.  Grapes  are  objectionable  only  on  account 
of  the  seeds.  With  most  of  the  other  fruits  it  is  the 
excess  in  quantity  which  makes  them  injurious. 

GENERAL  EULES  TO  BE  OBSERVED  IN  FEEDING 

Learning  to  eat  proper  things  in  a  proper  way 
forms  a  large  part  of  a  child's  early  education.  If 
careful  training  in  these  matters  is  begun  at  the  out- 
set and  continued,  the  results  will  well  repay  the 
time  and  effort  required.  A  child  who  has  been 
trained  to  eat  properly  can  usually  be  trained  to  do 
anything  else  that  is  important. 

Whether  the  child  feeds  himself  or  is  fed  by  the 
nurse,  the  following  rules  should  be  observed: 

1.  Food  at  regular  hours  only;  nothing  between 
meals. 

2.  Plenty  of  time  should  be  taken.  On  no  ac- 
count should  the  child  bolt  his  food. 

3.  The  child  must  be  taught  to  chew  his  food. 
Yet  no  matter  how  much  pains  are  taken  in  this  re- 
spect, mastication  is  very  imperfectly  done  by  all 
children;  hence  up  to  the  seventh  year  at  least,  all 


GENERAL  RULES  TO  BE  OBSERVED  IN  FEEDING  109 

meats  should  be  very  finely  cut,  all  vegetables  mashed 
to  a  pulp,  and  all  grains  cooked  very  soft. 

4.  Children  should  not  be  continually  urged  to 
eat  if  they  are  disinclined  to  do  so  at  their  regular 
hours  of  feeding,  or  if  the  appetite  is  habitually 
poor,  and  under  no  circumstances  should  a  child  be 
forced  to  eat. 

5.  Indigestible  food  should  never  be  given  to 
tempt  the  appetite  when  the  ordinary  simple  food  is 
refused;  food  should  not  be  allowed  between  meals 
because  it  is  refused  at  meal-time. 

6.  One  serious  objection  to  allowing  young  chil- 
dren highly  seasoned  food,  entrees,  jellies,  pastry, 
sweets,  etc.,  even  in  such  small  amounts  as  not  to 
upset  the  digestion,  is  that  children  thus  indulged 
soon  lose  appetite  for  the  simple  food  which  pre- 
viously was  taken  with  relish. 

7.  If  there  is  any  important  article  of  a  simple 
diet  such  as  milk,  meat,  cereals,  or  vegetables,  which 
a  child  habitually  refuses,  this  should  always  be 
given  first  at  the  meal  and  other  food  withheld 
until  it  is  disposed  of.  Children  so  readily  form 
habits  of  eating  only  certain  things  and  refusing 
others  that  such  an  inclination  should  be  checked 
early. 

8.  If  an  infant  refuses  its  food  altogether,  or 
takes  lesa  than  usual,  the  food  should  be  examined 


110      THE  CARE  AND  FEEDING  OF  CHILDREN 

to  see  if  this  is  right.  Then  the  mouth  should  be 
inspected  to  see  if  it  is  sore.  If  neither  of  these 
things  is  the  cause,  the  food  should  be  taken  away 
and  not  offered  again  until  the  next  feeding  time 
comes. 

9.  In  any  acute  illness  the  amount  of  food  should 
be  much  reduced  and  the  food  made  more  dilute  than 
usual.  If  there  is  fever,  no  solid  food  should  be 
given.  If  the  child  is  already  upon  a  milk  diet,  this 
should  be  diluted,  and  in  some  cases  partially  pep- 
tonized. 

10.  In  very  hot  weather  the  same  rules  hold,  to 
give  less  food,  particularly  less  solid  food,  and  more 
water. 

FOOD   rOEMITLAS 

Beef  Juice. — One  pound  of  rare  round  steak,  cut 
thick,  slightly  broiled,  and  the  juice  pressed  out  by 
a  lemon-squeezer,  or,  better,  a  meat-press.  From 
two  to  four  ounces  of  juice  can  generally  be  ob- 
tained. This,  seasoned  with  salt,  may  be  given  cold, 
or  warmed  by  placing  the  cup  which  holds  it  in 
warm  water.  It  should  not  be  heated  sufficiently  to 
coagulate  the  albumin  which  is  in  solution,  and 
which  then  appears  as  flakes  of  meat  floating  in  the 
fluid. 


FOOD  FORMULAS  111 


Beef  Juice  hy  the  Cold  Process. — One  pound  of 
finely  chopped  round  steak,  six  ounces  of  cold  water, 
a  pinch  of  salt;  place  in  a  covered  jar  and  stand  on 
ice  or  in  a  cold  place,  five  or  six  hours  or  overnight. 
It  is  well  to  shake  occasionally.  This  is  now  strained 
and  all  the  juice  squeezed  out  by  placing  the  meat  in 
coarse  muslin  and  twisting  it  very  hard.  It  is  then 
seasoned  and  fed  like  the  above. 

Beef  juice  so  made  is  not  quite  as  palatable  as 
that  prepared  from  broiled  steak,  but  it  is  even  more 
nutritious,  and  is  more  economical,  as  fully  twice  as 
much  juice  can  be  obtained  from  a  given  quantity  of 
meat.  Beef  juice  prepared  in  either  of  these  ways 
is  greatly  to  be  preferred  to  the  beef  extracts  sold. 

Mutton  Broth. — One  pound  of  finely  chopped 
lean  mutton,  including  some  of  the  bone,  one  pint 
cold  water,  pinch  of  salt.  Cook  for  three  hours  over 
a  slow  fire  down  to  half  a  pint,  adding  water  if  neces- 
sary ;  strain  through  muslin,  and  when  cold  carefully 
remove  the  fat,  adding  more  salt  if  required.  It  may 
be  fed  warm,  or  cold  in  the  form  of  a  jelly. 

A  very  nutritious  and  delicious  broth  is  made  by 
thickening  this  with  cornstarch  or  arrowroot,  cook- 
ing for  ten  minutes  and  then  adding  three  ounces  of 
milk,  or  one  ounce  and  a  half  of  thin  cream,  to  a  half 
pint  of  broth. 


112       THE  CARE  AND  FEEDING  OF  CHILDREN 

Chicken,  Veal,  and  Beef  Broths. — These  are 
made  and  used  in  precisely  the  same  manner  as  mut- 
ton broth. 

Meat  Pulp. — A  rare  piece  of  round  or  sirloin 
steak,  the  outer  part  having  been  cut  away,  is 
scraped  or  shredded  with  a  knife;  one  teaspoonful 
to  one  tablespoonful  may  be  given,  well  salted,  to  a 
child  of  eighteen  months.  Scraping  is  much  better 
than  cutting  the  meat  fine. 

For  this  on  a  large  scale,  as  in  institutions,  a 
Hamburg-steak  cutter  may  be  employed. 

Junhet,  or  Curds  and  Whey. — One  pint  of  fresh 
cow's  milk,  warmed;  pinch  of  salt;  a  teaspoonful 
of  granulated  sugar;  add  two  teaspoonfuls  of  Fair- 
child's  essence  of  pepsin,  or  liquid  rennet,  or  one 
junket  tablet  dissolved  in  water ;  stir  for  a  moment, 
and  then  allow  it  to  stand  at  the  temperature  of 
the  room  for  twenty  minutes,  or  until  firmly  coagu- 
lated; place  in  the  ice  box  until  thoroughly  cold. 
For  older  children  this  may  be  seasoned  with  grated 
nutmeg. 

Whey. — The  coagulated  milk  prepared  as  above 
is  broken  up  with  a  fork  and  the  whey  strained  off 
through  muslin.  It  is  best  given  cold.  If  some 
stimulant  is  desired,  sherry  wine  in  the  proportion 
of  one  part  to  twelve,  or  brandy  one  part  to  twenty- 


FOOD  FORMULAS  113 


four,  may  be  added.     Whey  is  useful  in  many  cases 
of  acute  indigestion. 

Barley  Jelly  from  the  Grains. — Three  table- 
spoonfuls  of  pearl  barley ;  soak  overnight,  then  place 
this  in  one  quart  of  fresh  water;  add  pinch  of  salt, 
and  cook  in  double  boiler  steadily  for  four  hours 
down  to  one  pint,  adding  water  from  time  to  time; 
strain  through  muslin.  When  cold  this  makes  a 
rather  thick  jelly.  If  a  thinner  gruel  (barley  water) 
is  desired,  one  half  the  quantity  of  barley  should  be 
used. 

Oat,  Wheat,  or  Rice  Jelly. — These  are  prepared 
from  oatmeal,  wheaten  grits,  and  rice  grains  in  the 
same  manner  as  the  barley  jelly. 

Barley  Jelly  from  the  Flour. — ^Either  Robin- 
son's patent  barley  or  prepared  barley  flour  of  the 
Health  Food  Company  may  be  used.  One  rounded 
tablespoonful  of  the  flour,  thoroughly  blended  with 
a  little  cold  water,  is  added,  stirring,  to  one  pint  of 
boiling  water  containing  a  pinch  of  salt;  cook  for 
twenty  minutes  in  a  double  boiler,  and  strain.  This 
makes  a  jelly  of  about  the  consistency  of  that  made 
from  the  grains  as  above.  It  is  essentially  the  same 
in  composition,  and  much  less  trouble  to  prepare.  A 
thinner  gruel  (barley  water)  is  made  by  using  half 
the  quantity  of  flour. 


114       THE  CARE  AND  FEEDING  OF  CHILDREN 

When  this  is  to  be  mixed  with  milk,  it  is  well  to 
add  the  milk  to  the  barley  gruel  before  removing 
from  the  fire,  and  stir  two  or  three  minutes,  or  until 
the  milk  has  nearly  reached  the  boiling  point,  when 
it  should  be  removed  and  bottled. 

Oat  or  Wheat  Jelly  from  the  Flour. — These  are 
made  from  the  prepared  oat  flour  of  the  Health  Food 
Company  or  HubbelFs  prepared  wheat  flour.  They 
are  used  like  the  barley. 

Imperial  Granum. — This  is  prepared  and  used 
in  precisely  the  same  way  as  the  barley  flour  above 
mentioned,  the  gruel  being  mixed  with  milk  before 
it  is  removed  from  the  fire. 

Albumin  Water. — The  white  of  one  fresh  egg; 
half  a  pint  of  cold  water ;  pinch  of  salt ;  teaspoonf ul 
of  brandy.  This  should  be  shaken  thoroughly  and 
fed  cold  either  with  a  spoon  or  from  a  bottle.  It  is 
useful  in  cases  of  vomiting,  and  can  sometimes  be 
retained  by  a  very  irritable  stomach. 

Lime-water. — One  heaping  teaspoonful  of  slaked 
lime ;  one  quart  boiled  or  distilled  water ;  place  in  a 
corked  bottle  and  shake  thoroughly  two  or  three 
times  during  the  first  hour.  The  lime  should  then 
be  allowed  to  settle,  and  after  twenty-four  hours  the 
upper  clear  fluid  carefully  poured  or  siphoned  off 
for  use. 


POOD  FORMULAS  116 

Dried  Bread. — Either  stale  or  fresh  bread  may 
be  used;  it  is  cut  in  thin  slices  and  placed  in  the 
oven,  with  the  door  open,  and  quickly  dried  until 
it  is  crisp,  but  not  browned.  It  is  in  many  respects 
preferable  to  crackers  for  little  children. 

Coddled  Egg. — A  fresh  egg,  shell  on,  is  placed 
in  boiling  water  which  is  immediately  after  removed 
from  the  fire.  The  egg  then  cooks  slowly  in  the 
water,  which  gradually  cools,  for  seven  or  eight  min- 
utes, when  the  white  should  be  about  the  consistency 
of  jelly.  For  a  delicate  digestion  the  white  only 
should  be  given,  with  salt ;  it  can  be  easily  separated 
from  the  yolk. 


m 

MISCELLANEOUS 

THE    BOWELS 

How  many  movements  daily  should  an  infant 
have  during  the  first  few  weeks  of  life? 

Usually  two  or  three  a  day  for  the  first  week, 
and  then  one  or  two  each  day. 

How  many  after  a  child  is  a  month  old? 

A  healthy  child  should  have  at  least  one  move- 
ment each  day ;  many  have  two  and  some  more  than 
two ;  but  it  is  the  character  of  the  stools  rather  than 
their  number  which  is  to  be  taken  as  the  evidence 
of  perfect  digestion. 

What  is  the  appearance  of  a  healthy  movement 
of  a  child  who  is  taking  nothing  hut  milk? 

It  is  soft,  yellow,  and  smooth,  containing  no 
lumps. 

When  are  the  stools  dark  brown  or  black? 
While  taking  bismuth,  iron,  and  sometimes  when 
taking  much  meat  or  beef  juice;  also  while  taking 
116 


THE  BOWELS  117 


many  of  the  prepared  foods.  They  may  be  dark 
brown  or  black  from  blood.  This  last  is  a  condition 
which  may  indicate  serious  illness. 

How  may  a  child  be  trained  to  he  regular  in  the 
action  of  its  bowels? 

By  endeavouring  to  have  them  move  at  exactly 
the  same  time  every  day. 

At  what  age  may  an  infant  be  trained  in  this 
way? 

Usually  by  the  second  month  if  training  is  begun 
early. 

What  is  the  best  method  of  training? 

A  small  chamber,  about  the  size  of  a  pint  bowl, 
is  placed  between  the  nurse's  knees,  and  upon  this 
the  infant  is  held,  its  back  being  against  the  nurse's 
chest  and  its  body  firmly  supported.  This  should  be 
done  twice  a  day,  after  the  morning  and  afternoon 
feedings,  and  always  at  the  same  hour.  At  first  there 
may  be  necessary  some  local  irritation,  like  that  pro- 
duced by  tickling  the  anus  or  introducing  just  inside 
the  rectum  a  small  cone  of  oiled  paper  or  a  piece  of 
soap,  as  a  suggestion  of  the  purpose  for  which  the 
baby  is  placed  upon  the  chamber;  but  in  a  surpris- 
ingly short  time  the  position  is  all  that  is  required. 
With  most  infants,  after  a  few  weeks  the  bowels  will 
move  as  soon  as  the  infant  is  placed  on  the  chamber. 


118      THE  CARE  AND  FEEDING  OP  CHILDREN 

What  advantage  has  such  training  f 
It  forms  the  habit  of  having  the  bowels  move 
regularly  at  the  same  hour,  which  is  a  matter  of 
great  importance  in  infancy  and  makes  regularity 
in  childhood  much  easier.  It  also  saves  the  nurse 
much  trouble  and  labour. 

SLEEP 

Should  a  child  sleep  in  the  same  bed  with  its 
mother  or  nurse  ? 

Under  no  circumstances,  if  this  can  possibly  be 
avoided.  Very  young  infants  have  often  been  smoth- 
ered by  their  mothers,  by  overlying  during  sleep.  If 
the  infant  sleeps  with  the  mother,  there  is  always  the 
temptation  to  frequent  nursing  at  night,  which  is  in- 
jurious to  both  mother  and  child.  Older  children 
also  should,  if  possible,  have  separate  beds;  many 
contagious  diseases  and  bad  habits  are  contracted  by 
children  sleeping  together. 

How  should  an  infant's  bed  be  prepared? 

The  mattress  should  be  firm  but  soft,  the  pillow 
very  thin,  and  the  covering  not  excessive.  A  baby 
should  not  be  allowed  to  sleep  always  in  the  same 
position,  but  should  be  changed  from  side  to  side. 
Hair  pillows  are  useful  in  summer  and  for  children 
who  perspire  very  much. 


SLEEP  119 

How  much  sleep  is  natural  for  a  newly  horn 
hahy? 

A  baby  with  a  good  digestion  and  proper  food 
will  usually  sleep  at  this  period  about  nine  tenths 
of  the  time. 

How  much  should  a  hahy  sleep  at  six  months? 
About  two  thirds  of  the  time. 

Up  to  what  age  should  an  older  child  take  a  nap 
during  the  day? 

Always  until  four  years  old,  and  if  possible 
longer. 

At  what  age  may  an  infant  go  all  night  without 
feeding  ? 

At  five  months  a  child  should  not  be  fed  or 
nursed  between  10  p,  m.  and  6  a.  m.  At  two  years 
a  child  can  easily  go  from  6  p.  m.  to  6  a.  m.  without 
feeding. 

How  should  a  hahy  he  put  to  sleep  ? 

The  room  should  be  darkened  and  quiet,  the 
child's  hunger  satisfied,  and  the  child  made  gen- 
erally comfortable  and  laid  in  its  crib  while 
awake. 

Is  rocJcing  necessary? 

By  no  means.  It  is  a  habit  easily  acquired,  but 
hard  to  break,  and  a  very  useless  and  sometimes  in- 


120      THE  CARE  AND  FEEDING  OF  CHILDREN 

jurious  one.  The  same  may  be  said  of  sucking  a 
rubber  nipple,  or  "  pacifier,"  and  all  other  devices 
for  putting  children  to  sleep. 

What  are  the  principal  causes  of  disturbed 
sleep  ? 

As  quiet  peaceful  sleep  is  a  sign  of  perfect 
health,  disorders  of  sleep  may  be  produced  by  al- 
most anything  which  is  wrong  with  the  child. 

1.  Habitual  disturbance  of  sleep  in  infants  is 
most  frequently  associated  with  the  food  or  feeding. 
It  may  be  from  the  discomfort  of  chronic  indigestion 
due  to  improper  food.  In  bottle-fed  infants  it  is 
often  the  result  of  overfeeding;  in  those  who  are 
nursed  it  is  often  due  to  hunger.  A  common  cause 
is  frequent  night  feeding ;  an  infant  who  is  fed  three 
or  four  times  during  the  night  is  almost  invariably 
a  bad  sleeper. 

2.  Disturbed  sleep  or  sleeplessness  may  be  due 
to  causes  purely  nervous.  Such  are  bad  habits  ac- 
quired by  faulty  training;  as  when  the  nursery  is 
lighted  and  the  child  taken  from  its  crib  whenever 
it  wakes  or  cries;  or  when  some  of  the  contrivances 
for  inducing  sleep  have  been  used.  Any  excitement 
or  romping  play  just  before  bedtime,  and  fears 
aroused  by  pictures  or  stories,  are  frequent  causes. 
Children  who  inherit  from  their  parents  a  nervous 


SLEEP  121 

constitution  are  more  likely  to  suffer  from  sleep  dis- 
turbances than  are  others. 

3.  There  may  be  physical  discomfort  from  cold 
feet,  insufficient  or  too  much  clothing,  want  of  fresh 
air  in  the  sleeping  room,  or  interference  with  easy 
breathing  due  to  obstruction  from  large  tonsils  or 
adenoids. 

4.  Chronic  pains  or  frequently  recurring  night 
pains  may  be  causes  of  disordered  sleep,  when  a 
child  wakes  with  a  sudden  sharp  cry.  In  infants 
this  is  most  often  due  to  scurvy,  sometimes  to  syph- 
ilis. In  older  children  it  may  be  the  earliest  symp- 
tom of  disease  of  the  hip  or  spine. 

5.  Sleeplessness  and  disturbed  sleep  are  frequent 
whenever  the  general  condition  falls  much  below  a 
healthy  standard.  Thus  they  are  seen  in  infants 
who  are  not  thriving  and  in  children  suffering  from 
marked  ansemia. 

How  are  children  who  sleep  too  little,  or  whose 
sleep  is  constantly  disturbed,  to  he  treated? 

Never  by  the  use  of  soothing  sirups  or  other 
medicines.  Successful  treatment  consists  in  the  dis- 
covery and  removal  of  the  cause  of  the  disturb- 
ance. 

Do  children  ever  sleep  too  much? 

It  is  doubtful  if  healthy  children  ever  do.     Ex- 


123       THE  CARE  AND  FEEDING  OF  CHILDREN 

cessive  sleep  is  an  important  symptom  of  some  dis- 
eases of  the  brain.  Otherwise  it  seldom  if  ever  oc- 
curs unless  soothing  sirups  or  other  drugs  have  been 
given. 

EXEECISE 

Is  exercise  important  for  infants? 

It  is  as  necessary  for  them  as  for  older  children. 

How  is  it  obtained? 

A  young  baby  gets  its  exercise  by  screaming, 
waving  its  arms,  kicking,  etc.  The  clothing  should 
not  be  so  tight  as  to  make  these  movements  impos- 
sible. At  least  twice  a  day  the  infant  should  be 
allowed  for  fifteen  or  twenty  minutes  the  free  use  of 
its  limbs  by  permitting  it  to  lie  upon  a  bed  in  a 
warm  room,  with  all  clothing  except  the  shirt,  stock- 
ings, and  napkin  removed.  Later,  when  in  short 
clothes,  the  baby  may  be  put  upon  a  thick  blanket 
or  quilt  laid  upon  the  floor,  and  be  allowed  to  tumble 
about  at  will.  A  nursery  fence  two  feet  high,  made 
to  surround  a  mattress,  is  an  excellent  device  and 
makes  a  convenient  box  stall  for  the  young  animal, 
where  it  can  learn  to  use  both  its  arms  and  legs  with- 
out the  danger  of  injury.  Only  by  exercise  such  as 
this  do  the  muscles  have  an  opportunity  to  develop 
properly. 


THE  CRY  123 


THE    CEY 


When  is  crying  useful  f 

In  the  newly  born  infant  the  cry  expands  the 
lungs,  and  it  is  necessary  that  it  should  be  repeated 
for  a  few  minutes  every  day  in  order  to  keep  them 
well  expanded. 

How  much  crying  is  normal  for  a  very  young 
haby? 

From  fifteen  to  thirty  minutes  a  day  is  not  too 
much. 

What  is  the  nature  of  this  cry? 

It  is  loud  and  strong.  Infants  get  red  in  the 
face  with  it;  in  fact,  it  is  a  scream.  This  is  neces- 
sary for  health.     It  is  the  baby's  exercise. 

When  is  a  cry  abnormal? 

When  it  is  too  long  or  too  frequent.  The  ab- 
normal cry  is  rarely  strong,  often  it  is  a  moan- 
ing or  a  worrying  cry,  sometimes  only  a  feeble 
whine. 

What  are  the  causes  of  such  crying? 
Pain,  temper,  hunger,  illness,  and  habit. 

What  is  the  cry  of  pain  ? 

It  is  usually  strong  and  sharp,  but  not  generally 
continuous.    It  is  accompanied  by  contraction  of  the 


124       THE  CARE  AND  FEEDING  OF  CHILDREN 

features,  drawing  up  of  the  legs,  and  other  symptoms 
of  distress. 

What  is  the  cry  of  hunger? 
It  is  usually  a  continuous,  fretful  cry,  rarely 
strong  and  lusty. 

What  is  the  cry  of  temper? 
It  is  loud  and  strong  and  accompanied  by  kick- 
ing or  stiffening  of  the  body,  and  is  usually  violent. 

What  is  the  cry  of  illness? 

There  is  usually  more  of  f  retf  ulness  and  moaning 
than  real  crying,  although  crying  is  excited  by  very 
slight  causes. 

What  is  the  cry  of  indulgence  or  from  habit  ? 

This  is  often  heard  even  in  very  young  infants, 
who  cry  to  be  rocked,  to  be  carried  about,  sometimes 
for  a  light  in  the  room,  for  a  bottle  to  suck,  or  for 
the  continuance  of  any  other  bad  habit  which  has 
been  acquired. 

How  can  we  he  sure  that  a  child  is  crying  to  he 
indulged? 

If  it  stops  immediately  when  it  gets  what  it 
wants,  and  cries  when  it  is  withdrawn  or  withheld. 

What  should  he  done  if  a  hahy  cries  at  night? 
One  should  get  up  and  see  that  the  child  is  com- 


LIFTING  CHILDRBN  125 

fortable — the  clothing  smooth  under  the  body,  the 
hands  and  feet  warm,  and  the  napkin  not  wet  or 
soiled.  If  all  these  matters  are  properly  adjusted 
and  the  child  simply  crying  to  be  taken  up,  it  should 
not  be  further  interfered  with.  If  the  night  cry  is 
habitual  some  other  cause  should  be  sought  (see 
page  121). 

How  is  an  infant  to  he  managed  that  cries  from 
temper,  hahit,  or  to  he  indulged?  /\ 

It  should  simply  be  allowed  to  "  cry  it  out." 
This  often  requires  an  hour,  and  in  extreme  cases, 
two  or  three  hours.  A  second  struggle  will  seldom 
last  more  than  ten  or  fifteen  minutes,  and  a  third 
will  rarely  be  necessary.  Such  discipline  is  not  to 
be  carried  out  unless  one  is  sure  as  to  the  cause  of 
the  habitual  crying. 

7s  it  liJcely  tJiat  rupture  will  he  caused  from  cry- 
ing? 

iNTot  in  young  infants  if  the  abdominal  band  is 
properly  applied,  and  not  after  a  year  under  any 
circumstances. 

LIFTING    CHILDEEN 

How  should  a  young  hahy  he  lifted  from  its  hedf 

The  right  hand  should  grasp  the  clothing  below 

the  feet,  and  the  left  hand  should  be  slipped  beneath 


126       THE  CAKE  AND  FEEDING  OF  CHILDREN 

the  infant's  body  to  its  head.    It  is  then  raised,  upon 
the  left  arm. 

What  is  the  advantage  of  this? 

The  entire  spine  is  supported,  and  no  undue  pres- 
sure is  made  upon  the  chest  or  abdomen,  as  often 
happens  if  the  baby  is  grasped  around  the  body  or 
under  the  arms. 

How  should  a  child  old  enough  to  run  about  he 
lifted? 

Always  by  placing  the  hands  under  the  child's 
arms,  and  never  by  the  wrists. 

What  injury  may  he  inflicted  hy  lifting  the  child 
hy  the  wrists  or  hands? 

Often  serious  injury  is  done  to  the  elbow  or 
shoulder  joints. 

THE    TEMPERATTJEE 

What  is  the  normal  temperature  of  an  infant? 

The  normal  temperature  varies  more  than  in 
adults.  In  the  rectum  it  usually  fluctuates  between 
98°  and  99.5°  F. ;  a  rectal  temperature  of  9Y.5°  F. 
or  of  100.5°  F.  is  of  no  importance  whatever  un- 
less it  continues. 

Where  should  the  temperature  of  infants  and 
young  children  he  taken? 


THE  TEMPERATURE  127 

The  rectum  is  altogether  the  best  place,  and  next 
to  this  the  groin.  The  rectal  temperature  is  from 
half  a  degree  to  a  degree  higher  than  that  in  the 
groin. 

How  long  should  the  thermometer  he  left  in 
'place  to  take  the  temperature? 

Two  minutes  in  the  rectum,  and  five  minutes  in 
the  groin. 

Is  the  temperature  of  a  young  child  a  good  guide 
as  to  the  severity  of  its  symptoms  in  illness? 

As  a  rule  it  is.  A  temperature  of  100°  to  102° 
F.  commonly  means  a  mild  illness,  and  one  of  104° 
F.  or  over  a  serious  one.  The  duration  of  the  fever 
is,  however,  even  more  important  than  the  height  of 
the  temperature.  It  should  be  remembered  that  in 
all  young  children  slight  causes  often  produce  a  high 
temperature  which  lasts  for  a  few  hours ;  one  should 
not  therefore  be  unduly  alarmed  unless  the  tempera- 
ture continues  high,  or  is  accompanied  by  other  im- 
portant signs  of  illness. 

Is  not  a  high  temperature  a  more  serious  symp- 
tom in  a  young  child  than  in  an  adult? 

The  opposite  is  rather  the  case.  Young  children 
are  extremely  sensitive  to  conditions  which  produce 
fever,  and  the  thermometer  often  gives  an  exagger- 
ated idea  of  the  severity  of  the  symptoms.    A  cause 


128      THE  CARE  AND  FEEDING  OP  CHILDREN 

which  in  an  adult  might  produce  a  temperature  of 
102°  F.  or  103°  F.,  in  a  young  child  would  very 
likely  be  accompanied  by  a  temperature  of  104°  or 
105°  F. 

NEEVOUSNESS 

What  are  the  principal  causes  of  excessive  nerv- 
ousness in  infants  and  young  children,  and  what  can 
he  done  to  prevent  this? 

The  most  important  cause  is  the  delicate  struc- 
ture of  the  brain  at  this  time,  and  its  rapid  growth. 
It  grows  as  much  during  the  first  year  as  during  all 
the  rest  of  life.  This  requires  quiet  and  peaceful 
surroundings.  Infants  who  are  naturally  nervous 
should  be  left  much  alone,  should  see  but  few  people, 
should  be  played  with  very  little,  and  should  never 
be  quieted  with  soothing  sirups  or  the  "  pacifier." 

At  what  age  may  playing  with  hahies  he  hegun? 

Babies  under  six  months  old  should  never  be 
played  with ;  and  the  less  of  it  at  any  time  the  bet- 
ter for  the  infant. 

What  harm  is  done  hy  playing  with  very  young 
hahies  f 

They  are  made  nervous  and  irritable,  sleep  bad- 
ly, and  suffer  from  indigestion  and  in  many  other 
respects. 


TOYS  129 

When  may  young  children  he  played  with? 
If  at  all,  in  the  morning,  or  after  the  midday 
nap;  but  never  just  before  bedtime. 

TOYS 

What  points  should  guide  one  in  selecting  toys 
and  playthings  for  an  infant? 

The  instinct  in  a  baby  to  put  everything  into  the 
mouth  is  so  strong  that  nothing  should  be  given  that 
cannot  be  safely  treated  in  this  way.  Hence  one 
should  choose  things  which  are  smooth,  those  which 
can  be  easily  washed,  and  those  which  cannot  be 
swallowed. 

One  should  avoid  (1)  toys  with  sharp  points  or 
corners;  (2)  those  with  loose  parts  that  might  be  de- 
tached or  broken  off  and  swallowed;  (3)  small  ob- 
jects which  might  be  swallowed  or  pushed  into  the 
nose  or  ear,  such  as  coins,  marbles,  and  safety-pins, 
also  beads  and  buttons  unless  strung  upon  a  stout 
cord;  (4)  painted  toys;  (5)  those  covered  with  hair 
or  wool.  Infants  have  often  been  severely  injured 
by  swallowing  what  they  have  pulled  off  from  their 
small  toy  animals. 

What  points  are  to  he  considered  in  selecting  the 
toys  and  playthings  of  a  child  over  two  years  old? 
It  should  be  remembered  that  toys  are  not  mere- 
9 


180      THE  CARE  AND  FEEDING  OP  CHILDREN 

ly  a  source  of  amusement,  but  that  they  have  an 
educational  value  as  well.  Those  are  therefore  to 
be  preferred  the  use  of  which  develops  the  child's 
imagination,  and  with  which  he  can  be  taught  to 
amuse  himself.  For  boys  nothing  can  surpass  blocks, 
toy  soldiers,  balls,  engines,  and  cars;  and  for  girls, 
dolls  and  housekeeping  sets.  The  complicated  me- 
chanical toys  now  so  much  in  vogue  give  only  a 
momentary  pleasure,  and  as  soon  as  the  wonder  at 
their  operation  has  worn  off,  they  have  lost  interest 
for  the  child  except  that  which  he  gets  in  breaking 
them  to  see  how  the  thing  worked. 

What  important  things  can  he  taught  children 
with  their  toys  and  how  may  this  he  done? 

The  imagination  may  be  developed,  and  children 
may  be  trained  to  habits  of  neatness,  order  and  regu- 
larity, and  to  concentration  of  mind. 

To  this  end  toys  should  be  kept  in  an  orderly 
way  upon  a  shelf  in  the  nursery  or  in  a  closet,  never 
piled  in  a  miscellaneous  heap  in  the  corner  of  the 
room.  Children  should  select  their  toys  and  play 
with  one  thing  at  a  time,  which  they  should  be  taught 
to  put  away  in  its  place  before  another  is  given. 
They  should  never  be  allowed  to  have  a  dozen  things 
strewn  about  the  room  at  one  time,  with  none  of 
which  they  are  occupied. 


KISSING— CONVULSIONS  131 


KISSING 

Are  there  any  valid  objections  to  hissing  in- 
fants? 

There  are  many  serious  objections.  Tuberculo- 
sis, diphtheria,  and  many  other  grave  diseases  may 
be  communicated  in  this  way.  The  kissing  of  in- 
fants upon  the  mouth  by  other  children,  by  nurses,  or 
by  people  generally,  should  under  no  circumstances 
be  permitted.  Infants  should  be  kissed,  if  at  all, 
upon  the  cheek  or  forehead,  but  the  less  even  of  this 
the  better. 

CONVULSIONS 

What  should  he  done  for  a  child  in  convulsions 
before  a  doctor  arrives? 

Keep  the  child  perfectly  quiet  with  ice  at  the 
head,  put  the  feet  in  a  mustard  bath,  and  roll  the 
entire  body  in  large  towels  which  have  been  dipped 
in  mustard  water  (two  heaping  tablespoonfuls  of 
mustard  to  one  quart  of  tepid  water),  and  have 
plenty  of  hot  water  and  a  bath  tub  at  hand,  so  that 
the  doctor  can  give  a  hot  bath  if  he  thinks  it  advis- 
able. 

When  is  a  hot  hath  useful? 
If  the  convulsions  have  continued  until  the  pulse 
is  weak,  the  face  very  pale,  the  nails  and  lips  blue, 


133      THE  CARE  AND  FEEDING  OF  CHILDREN 

and  the  feet  and  hands  cold,  the  hot  bath  will  be 
useful  by  bringing  blood  to  the  surface  and  relieving 
the  heart,  lungs,  and  brain. 

How  should  the  hath  he  given? 

The  temperature  should  not  be  over  106°  F. ; 
this  should  always  be  tested  by  a  thermometer  if  one 
can  be  obtained.  Without  this  precaution,  in  the  ex- 
citement of  the  moment,  infants  have  frequently 
been  put  into  baths  so  hot  that  serious  and  even  fatal 
burns  have  been  produced.  If  no  thermometer  is 
available  the  nurse  may  plunge  her  arm  to  the  elbow 
into  the  water.  It  should  feel  warm,  but  not  so  hot 
as  to  be  at  all  uncomfortable.  One  half  a  teacupful 
of  powdered  mustard  added  to  the  bath  often  adds 
to  its  efficacy. 

FOEEIGN    BODIES 

What  should  he  done  if  a  foreign  hody  has  been 
swallowed? 

First,  examine  the  throat  with  the  finger  to  see  if 
it  has  lodged  there,  and  if  so  remove  it.  If  it  has 
passed  from  the  throat  it  has  usually  gone  into  the 
stomach. 

What  should  he  done  in  this  case? 
Give  the  child  plenty  of  dry  food,  like  bread, 
potato,  etc.,  but  under  no  circumstances  either  an 


COLIC  133 

emetic  or  cathartic.     An  infant  may  have  its  usual 
food. 

What  harm  would  a  cathartic  do? 

It  is  likely  to  hurry  the  foreign  body  too  rap- 
idly through  the  intestine  and  in  this  way  do  harm; 
otherwise  it  becomes  coated  with  isacal  matter 
and  passes  the  intestine  usually  without  doing 
injury. 

What  should  he  done  if  a  child  gets  a  foreign 
body  into  the  ear? 

Unless  this  can  easily  be  removed  with  the  fin- 
gers it  should  not  be  meddled  with,  for  it  is  likely 
to  be  pushed  farther  into  the  ear.  The  child  should 
be  taken  to  a  physician. 

What  should  he  done  if  there  is  a  foreign  body 
in  the  nose? 

The  child  should  blow  his  nose  strongly  while 
the  empty  nostril  is  compressed.  Unless  this  removes 
it  a  physician  should  be  called.  Meddlesome  inter- 
ference is  always  harmful. 

COLIC 

What  are  the  symptoms  of  colic? 
There  is  a  strong,  hard  cry,  which  comes  sud- 
denly and  returns  every  few  minutes.     With  this 


134       THE  CARE  AND  FEEDING  OF  CHILDREN 

there  is  drawing  up  of  the  feet,  contraction  of  the 
muscles  of  the  face,  and  other  signs  of  pain.  The 
abdomen  is  usually  tense  and  hard. 

What  should  he  done  for  a  haby  with  colic  ? 

First,  see  that  the  feet  are  warm.  Place  them 
against  a  hot-water  bag,  or  hold  them  before  an  open 
fire;  apply  a  hot  flannel  to  the  abdomen,  or  let  the 
child  lie  upon  its  stomach  across  a  hot-water  bag. 
If  the  colic  continues,  a  half  teacupful  of  warm 
water  containing  ten  drops  of  turpentine  may  be  in- 
jected into  the  bowels  with  a  syringe;  at  the  same 
time  the  abdomen  should  be  gently  rubbed  so  as  to 
start  the  wind.  If  the  gas  is  in  the  stomach,  half  of 
a  soda  mint  tablet  may  be  given  in  a  tablespoonful 
of  very  warm  water. 

EABACHE 

What  are  the  symptoms  of  earache? 

The  pain  is  generally  severe  and  accompanied  by 
a  sharp  scream ;  the  child  often  puts  the  hand  to  the 
affected  ear,  or  cries  whenever  it  is  touched.  The 
pain  is  likely  to  be  prolonged  and  continuous. 

How  should  a  child  with  earache  he  treated? 

The  ear  should  be  irrigated  with  a  solution  of 
boric  acid  (twenty  grains  to  the  ounce)  as  warm  as 
can  be  borne.    Dry  heat  may  then  be  applied  in  sev- 


CROUP  135 

eral  ways.  The  ear  having  been  first  covered  with 
cotton,  a  small  hot-water  bag  or  one  filled  with  hot 
salt  or  bran,  may  be  bound  over  it  with  a  bandage ;  or 
a  small  butter  plate  heated  in  hot  water  may  be  used 
in  the  same  way.  The  hot-water  bag  may  be  held 
against  the  ear  or  the  child  may  lie  with  his  head 
upon  it.  The  use  of  such  substances  as  oil  and  lau- 
danum in  the  ear  is  not  to  be  recommended. 


CEOIJP 

What  are  the  symptoms  of  croup  ? 
There  is  a  hollow,  dry,  barking  cough,  with  some 
difficulty  in  breathing. 

When  is  this  likely  to  come  on? 
Usually  at  night. 

7s  simple  croup  dangerous? 

The  ordinary  croup  of  infants  is  spasmodic 
croup,  and  is  very  rarely  dangerous,  although  the 
symptoms  seem  very  alarming. 

What  are  the  symptoms? 

In  a  mild  attack  there  is  simply  noisy  breathing, 
especially  on  drawing  in  the  breath,  with  a  tight, 
barking,  or  croupy  cough.  In  a  severe  attack  the 
child's  breathing  is  more  noisy  and  becomes  diffi- 
cult. 


136       THE  CARE  AND  FEEDING  OF  CHILDREN 

What  is  the  dangerous  form  of  croup  f 
Membranous  croup,  which  is  the  same  thing  as 
diphtheria  of  the  larynx. 

How  does  this  develop? 

Gradually;  very  rarely  does  it  come  on  sud- 
denly. 

What  should  he  done  for  a  haby  who  has  spas- 
modic croup? 

The  room  should  be  very  warm,  hot  cloths  or  poul- 
tices should  be  applied  over  the  throat,  and  either  a 
croup  kettle  or  an  ordinary  tea-kettle  kept  boiling  in 
the  room.  This  is  more  efficacious  if  the  child  is 
placed  in  a  tent  made  by  a  raised  umbrella  with  a 
sheet  thrown  over  it,  and  the  steam  introduced  be- 
neath the  tent.  If  the  symptoms  are  urgent,  ten 
drops  of  the  sirup  of  ipecac  should  be  given  every 
fifteen  minutes  until  free  vomiting  occurs.  When- 
ever the  symptoms  reach  a  point  where  breathing  be- 
comes difficult,  a  doctor  should  be  summoned  without 
delay. 


CONTAGIOtrS    DISEASES 


What  are  the  first  symptoms  of  measles? 

Measles  comes  on  rather  gradually  with  cough, 
sneezing,  watery  eyes  and  nose,  much  like  an  ordi- 
nary cold  in  the  head.     The  eruption  appears  after 


CONTAGIOUS  DISEASES  137 

three  or  four  days,  first  upon  the  face  and  neck  as 
small  red  spots,  and  spreads  slowly  over  the  body. 

Is  measles  a  serious  disease  f 

In  infants  and  during  the  winter  season  it  is 
likely  to  be  very  serious  on  account  of  the  danger 
of  bronchitis  and  pneumonia,  which  frequently  ac- 
company it.  In  children  over  four  years  old  it  is 
generally  not  severe.  No  child  should  be  voluntarily 
exposed  to  this  disease,  and  particularly  one  who  is 
delicate  or  prone  to  disease  of  the  lungs  should  be 
protected  against  it. 

When  and  how  is  measles  contagious? 

Measles  may  readily  be  conveyed  in  the  early 
stage  and  from  the  very  beginning  of  the  catarrhal 
symptoms,  two  or  three  days  before  any  eruption  is 
present.  It  is  much  less  contagious  after  the  erup- 
tion fades.  Measles  is  not  often  carried  by  healthy 
persons.  Its  poison  does  not  cling  long  to  a  sick 
room. 

What  is  German  measles? 

German  measles,  or  rubella,  is  a  distinct  conta- 
gious disease  and  has  nothing  to  do  with  ordinary 
measles.  It  is  not  serious,  and  it  is  extremely  rare 
for  a  child  to  be  very  sick  with  it.  There  is  usually 
a  very  extensive  eruption  which  may  cover  the  body, 
but  there  are  very  few  other  symptoms. 


138       THE  CARE  AND  FEEDING  OP  CHILDREN 

What  are  the  first  symptoms  of  scarlet  fever? 

Generally  it  comes  suddenly,  with  vomiting,  high 
fever,  and  sore  throat.  The  eruption  usually  ap- 
pears within  twenty-four  hours  as  a  red  blush,  first 
upon  the  neck  and  chest,  and  spreads  rapidly  over 
the  body. 

When  and  how  is  scarlet  fever  contagious? 

Scarlet  fever  is  only  slightly  contagious  for  the 
first  one  or  two  days  of  the  attack.  It  is  most  con- 
tagious during  the  height  of  the  disease  and  during 
desquamation.  It  is  often  carried  by  healthy  per- 
sons and  by  the  clothing  or  bedding  of  one  sick  with 
it.     Its  poison  clings  long  to  the  sick-room. 

How  does  whooping-cough  hegin? 

For  a  week  or  ten  days  it  cannot  be  distin- 
guished from  an  ordinary  cold  on  the  chest.  Then 
the  attacks  of  coughing  gradually  become  harder  and 
last  longer,  the  child  gets  very  red  in  the  face  and 
sometimes  vomits  its  food.  After  a  severe  coughing 
fit  it  catches  its  breath  with  a  peculiar  noise  known 
as  the  "  whoop." 

How  does  chicTcen-pox  hegin? 

It  usually  comes  out  gradually,  as  widely  scat- 
tered pimples  over  the  scalp,  face,  and  body,  many 
of  which  soon  become  small  vesicles,  resembling  tiny 


CONTAGIOUS  DISEASES  139 

blisters.  There  is  itching  and  some  local  discomfort 
but  very  little  fever,  and  the  child  rarely  seems  to 
be  very  ill. 

How  does  diphtheria  begin? 

Sometimes  suddenly,  but  usually  very  gradually, 
with  sore  throat  and  often  swelling  of  the  glands  of 
the  neck,  with  white  patches  upon  the  tonsils,  or  a 
very  free  discharge,  which  may  be  bloody,  from  the 
nostrils. 

How  long  after  exposure  do  the  first  symptoms 
appear  in  the  different  diseases? 

In  scarlet  fever  in  from  three  to  five  days,  rarely 
later  than  a  week;  in  measles  in  from  nine  to  four- 
teen days,  occasionally  as  late  as  twenty  days;  in 
whooping-cough  in  from  one  to  two  weeks;  in 
chicken-pox  in  from  fourteen  to  sixteen  days ;  in  Ger- 
man measles  in  from  ten  to  sixteen  days.  In  diph- 
theria it  varies  much ;  it  may  be  only  one  day,  and  it 
may  be  one  or  two  weeks. 

Which  of  these  diseases  are  most  contagious? 

Measles  and  chicken-pox  are  very  contagious, 
and  very  few  children  who  have  not  had  them  can 
come  near  a  person  suffering  from  either  disease 
without  taking  it.  Whooping-cough  is  almost  as  con- 
tagious as  measles,  and  for  young  babies  even  more 


140      THE  CARE  AND  FEEDING  OF  CHILDREN 

SO.  A  very  close  exposure  is  not  necessary  in  the  case 
of  either  of  these  diseases,  and  whooping-cough  can 
undoubtedly  be  contracted  in  the  open  air.  Scarlet 
fever  and  diphtheria  are  much  less  contagious;  for 
both  of  these  a  pretty  close  exposure  is  necessary, 
and  even  then  many  who  are  exposed  escape. 

How  long  should  a  child  with  any  of  these  dis- 
eases he  kept  away  from  other  children? 

With  measles,  two  weeks  after  the  rash  has  gone ; 
with  scarlet  fever,  at  least  four  weeks  after  the  rash 
has  gone,  and  longer  if  the  peeling  is  not  over  or  if 
the  ears  are  running;  with  whooping-cough,  for  two 
months,  or  so  long  as  the  paroxsymal  cough  con- 
tinues ;  with  chicken-pox,  until  all  crusts  have  fallen 
off,  or  about  three  weeks  after  the  eruption  appears ; 
with  German  measles  for  one  week  after  the  erup- 
tion has  faded;  with  diphtheria  at  least  ten  days 
after  the  throat  is  well  in  a  very  mild  case,  and  four 
weeks  if  the  case  has  been  severe. 

What  should  he  done  when  a  child  shows  the  first 
symptoms  of  serious  illness? 

The  child  should  be  put  to  bed.  If  it  is  an  in- 
fant, the  food  should  be  diluted  to  one  half  the  usual 
strength;  if  an  older  child,  only  fluid  food  should 
be  given.  If  the  child  seems  feverish,  take  the  tem- 
perature.   If  the  bowels  are  constipated,  give  a  tea- 


SCURVY  141 

spoonful  of  castor  oil,  but  no  other  medicine  without 
the  doctor's  orders.  Send  for  the  doctor  at  once,  and 
until  he  comes  carefully  exclude  all  other  children 
from  the  room. 

By  what  nursery  training  may  the  examination 
and  treatment  of  sick  children  be  made  much  easier? 

By  teaching  all  children  to  gargle,  to  show  the 
throat,  to  take  pills,  and  by  constantly  teaching  them 
to  regard  the  doctor  as  the  child's  best  friend,  and 
his  visits  as  a  great  treat.  On  no  account  should  a 
child  be  frightened  into  obedience  by  threats  of  what 
the  doctor  will  do. 

With  care  and  patience  most  children  may  be 
taught  to  gargle  and  take  pills  at  four  or  five  years, 
and  to  show  the  throat  willingly  at  two  or  three.  All 
these  matters  should  be  made  a  part  of  the  child's 
education. 

SCURVY 

What  is  scurvy  and  how  is  it  produced? 

Scurvy  is  a  disease  of  general  nutrition,  usually 
caused  by  the  long-continued  use  of  improper  food. 
Most  of  the  cases  come  from  the  use  of  the  prepared 
infant's  foods  sold  in  the  stores,  especially  when  they 
are  given  without  fresh  milk;  occasionally  the  use 
of  condensed  milk  and  of  sterilized  milk  is  followed 
by  scurvy ;  sometimes  it  is  seen  when,  owing  to  feeble 


142      THE  CARE  AND  FEEDING  OF  CHILDREN 

digestion,  it  has  been  necessary  to  make  cow's  milk 
very  weak  for  a  long  time. 

What  symptoms  are  seen  in  an  infant  with 
scurvy? 

At  first  there  is  only  indefinite  and  occasional 
soreness  in  the  legs  so  that  the  child  cries  out  when 
handled.  As  this  soreness  becomes  more  severe  the 
child  is  often  thought  to  have  rheumatism.  The 
gums  swell  and  are  of  a  deep  purple  colour.  There 
may  be  bleeding  from  the  gums,  nose,  bowels,  or 
black-and-blue  spots  may  be  seen  upon  the  legs.  The 
ankles  and  knees  may  swell.  The  child  grows  very 
pale,  loses  appetite  and  weight,  and  sleeps  badly. 

What  should  he  done  when  an  infant  shows  signs 
of  scurvy? 

The  diet  should  at  once  be  changed  to  fresh  milk, 
properly  modified  according  to  the  child's  digestion, 
but  not  sterilized  or  pasteurized.  The  juice  of  a 
sweet  orange  should  be  given,  best  about  an  hour  be- 
fore the  feeding.  At  first  one  or  two  teaspoonfuls, 
four  or  five  times  a  day;  later,  more  may  be  given 
if  the  symptoms  are  not  improved. 

Properly  treated  an  infant  with  scurvy  generally 
recovers  promptly  and  completely.  If  not  recog- 
nised, or  untreated,  it  may  cause  death. 


CONSTIPATION  148 


CONSTIPATION 

When  it  is  necessary  to  move  the  howels  imme- 
diately, what  are  some  of  the  easiest  methods? 

An  injection  of  one  tablespoonful  of  sweet  oil 
may  be  given,  or  half  a  teaspoonful  of  glycerine  in 
one  tablespoonful  of  water,  or  a  teacupful  of  tepid 
soap  and  water,  or  a  glycerine  suppository.  IN^one  of 
these  should  be  continued  excepting  under  the  physi- 
cian's directions. 

What  sort  of  a  syringe  is  to  he  preferred  for  giv- 
ing an  injection  to  an  infant? 

The  bulb  syringe  is  the  simplest ;  this  consists  of 
an  oval  bulb  of  soft  rubber  and  a  soft  rubber  or  a 
hard  rubber  tip.    It  holds  one  or  two  ounces. 

What  is  the  most  essential  thing  in  preventing  or 
overcoming  constipation  ? 

The  formation  of  the  habit  of  having  the  bowels 
move  every  day  regularly  at  the  same  hour,  and 
proper  early  training  (see  page  117). 

What  is  the  best  hour? 

In  most  cases  immediately  after  the  first  meal 
in  the  morning. 

What  are  some  simple  means  hy  which  constipa- 
tion may  he  relieved? 

The  best  are  diet,  suppositories,  and  massage. 


144      THE  CARE  AND  FEEDING  OF  CHILDREN 

The  changes  to  be  made  in  the  milk  of  consti- 
pated infants  have  been  mentioned  on  page  77.  The 
addition  to  the  milk  of  some  of  the  malted  foods, 
such  as  Mellin's  food  or  malted  milk,  is  sometimes 
useful.  For  little  children  the  fruit  juices  are  par- 
ticularly beneficial  when  given  half  an  hour  or  more 
before  the  first  morning  feeding,  with  half  a  glass 
of  water. 

For  older  children  the  amount  of  white  bread, 
toast,  and  potato,  should  be  reduced,  and  green  vege- 
tables, oatmeal,  and  Graham  bread  given,  with 
plenty  of  fruit  twice  a  day.  Raw  scraped  apples  are 
sometimes  of  more  value  than  any  other  fruit. 

The  best  suppositories  for  continuous  use  are 
probably  the  gluten  suppositories  of  the  Health 
Food  Company.  One  should  be  given  the  first 
thing  in  the  morning.  They  act  rather  slowly,  usu- 
ally in  about  two  hours.  In  obstinate  cases  one  may 
also  be  used  at  bedtime.  Glycerine  suppositories 
act  more  quickly,  but  are  too  irritating  for  regu- 
lar use. 

Massage  consists  in  rubbing  the  abdomen,  which 
may  be  done  in  one  of  two  ways:  Beginning  at  the 
right  groin,  the  hand  is  carried  up  to  the  ribs,  then 
across  to  the  opposite  side,  then  around  to  the  left 
groin.  The  abdomen  is  stroked  gently  at  first,  and 
afterward  deeper  pressure  used  as  the  child  becomes 


DIARRflCEA  145 


accustomed  to  it.  The  second  method  is  by  rubbing 
the  deeper  parts  with  a  circular  movement — the  fin- 
gers not  moving  upon  the  skin — making  a  series  of 
small  circles,  beginning  at  the  right  groin  and  fol- 
lowing the  same  course  as  described  above.  Either 
method  should  be  employed  for  six  or  eight  minutes 
twice  a  day,  at  almost  any  regular  time,  except  soon 
after  a  meal. 

DIAEKHCEA 

In  case  a  child  is  taken  with  diarrhoea,  what 
should  be  done? 

With  a  moderate  looseness  of  the  bowels  in  an 
older  child,  solid  food  should  be  stopped,  and  boiled 
milk  given  diluted  with  gruel;  the  child  should  be 
kept  perfectly  quiet,  as  walking  about  always  aggra- 
vates such  a  disturbance.  If  the  symptoms  are  more 
severe  and  attended  by  fever  and  vomiting,  all  milk 
should  be  stopped  at  once,  and  only  broth,  barley 
water,  or  some  thin  gruel  given.  Some  cathartic, 
usually  castor  oil,  is  required  with  a  severe  attack. 

If  the  patient  is  an  infant,  the  milk  should  be 
diluted  and  especially  should  the  fat  be  reduced 
(see  page  Y8).  In  severe  attacks  with  vomiting  or 
frequent  foul  stools,  all  food  should  be  stopped  for  at 
least  twelve  hours  and  all  milk  for  a  longer  time,  and 
the  bowels  freely  moved  by  a  cathartic. 
10 


146       THE  CARE  AND  FEEDING  OP  CHILDREN 

Why  is  a  cathartic  necessary  if  the  movements 
are  already  frequent? 

Such  movements  are  nearly  always  due  to  an 
irritation  in  the  bowel,  set  up  by  the  fermenting 
food  which  has  not  been  digested.  The  diarrhoea 
is  Nature's  effort  to  get  rid  of  the  irritant.  Nothing 
to  stop  the  movements  should  be  given  until  the 
bowels  have  been  thoroughly  cleared  by  the  treat- 
ment mentioned. 

BAD    HABITS 

What  are  the  most  common  had  habits  of  young 
children  ? 

Sucking,  nail-biting,  dirt-eating,  bed-wetting, 
and  masturbation. 

What  do  children  sucTc? 

Most  frequently  the  thumbs  or  fingers,  sometimes 
the  clothing  or  blanket,  often  the  "  pacifier  "  or  rub- 
ber nipple. 

When  is  this  habit  most  frequently  seen? 

It  begins  in  quite  early  infancy,  and  if  not 
broken  may  last  until  children  are  six  or  seven 
years  old. 

Is  the  sucJcing  habit  a  harmful  one? 
When  persisted  in  it  may  produce  a  misshapen 
mouth  or  fingers.     It  constantly  stimulates  the  flow 


BAD  HABITS  147 


of  saliva  and  certainly  aggravates  disturbances  of 
digestion  during  which  the  sucking  habit  is  likely 
to  be  practised.  It  may  lead  to  thrush  or  other  forms 
of  infection  of  the  mouth.  It  is  not  necessary  as  a 
means  of  quieting  a  child,  though  it  may  in  some 
degree  cover  up  the  consequences  of  bad  feeding  or 
bad  training.  On  no  account  should  the  habit  of 
sucking  the  "  pacifier  "  be  allowed  as  a  means  of  put- 
ting children  to  sleep,  or  of  quieting  them  while  rest- 
less from  dentition  or  indigestion. 

How  is  the  sucking  habit  to  he  controlled? 

One  should  be  sure  in  the  first  place  that  the 
constant  sucking  of  fingers  is  not  due  to  hunger  from 
insufficient  food.  Sucking  of  the  hands  may  often 
be  controlled  by  wearing  mittens  or  fastening  the 
hands  to  the  sides  during  sleep.  In  more  obstinate 
cases  it  may  be  necessary  to  confine  the  elbow  by 
small  pasteboard  splints  to  prevent  the  child  from 
bending  the  arm  so  as  to  get  the  hand  to  the  mouth. 

When  are  nail-hiting  and  dirt-eating  seen^  and 
how  are  they  to  he  controlled? 

These  habits  belong  especially  to  children  over 
three  years  old.  They  are  seen  particularly  in  those 
who  are  excessively  nervous  or  whose  general  health 
is  below  par ;  sometimes  in  those  who  develop  serious 
nervous  diseases  later  in  life.     Children  with  such 


148       THE  CARE  AND  FEEDING  OF  CHILDREN 

tendencies  should  be  closely  watched,  and  every 
means  used  to  break  up  these  habits  early.  Dirt- 
eating  is  a  morbid  craving  which  is  rarely  seen  in 
a  normal  child. 

At  what  age  may  a  child  generally  he  expected 
to  go  without  wetting  the  hed  during  the  night? 

Usually  at  two  and  a  half  years,  if  it  is  taken  up 
late  in  the  evening.  Some  children  acquire  control 
of  the  bladder  at  night  when  two  years  old,  and  a 
few  not  until  three  years.  After  three  years  habit- 
ual bed-wetting  is  abnormal. 

How  should  a  young  child  addicted  to  hed-wet- 
ting  he  managed? 

At  three  or  four  years  of  age,  punishments  are 
sometimes  useful,  especially  when  it  seems  to  de- 
pend more  upon  the  child's  indifference  than  any- 
thing else.  They  are  of  no  value  in  older  children, 
rewards  being  much  more  efficacious.  In  all  cases 
one  should  give  a  child  plenty  of  milk  and  water 
early  in  the  day,  but  no  fluids  after  4  p.  m.,  the  sup- 
per being  always  of  solid  or  semi-solid  food.  The 
child  should  be  taken  up  regularly  at  ten  o'clock  or 
thereabouts.  It  often  happens  that  the  formation 
or  continuance  of  the  habit  is  due  to  the  child  being 
in  poor  general  condition,  to  some  irritation  in  the 
urine,  or  in  the  genital  organs.     Unless  the  simple 


BAD  HABITS  149 


means  mentioned  are  successful  the  child  should  be 
placed  under  the  charge  of  a  physician. 

What  is  masturbation? 

It  is  the  habit  of  rubbing  the  genital  organs  with 
the  hands,  with  the  clothing,  against  the  bed,  or  rub- 
bing the  thighs  together.  Sometimes  the  child  sits 
upon  the  floor,  crosses  its  thighs  tightly  and  rocks 
backward  and  forward.  Many  of  these  things  are 
passed  over  lightly  and  are  regarded  for  months  as 
simply  a  "  queer  trick  "  of  the  child.  It  may  be 
seen  at  any  age,  even  in  those  not  more  than  a  year 
old,  and  in  both  sexes. 

\       How  should  such  a  child  he  treated? 

/  Masturbation  is  the  most  injurious  of  all  the  bad 
habits,  and  should  be  broken  up  just  as  early  as  pos- 
sible. Children  should  especially  be  watched  at  the 
time  of  going  to  sleep  and  on  first  waking.  Punish- 
ments are  of  little  avail,  and  usually  make  matters 
worse.  Some  local  cause  of  irritation  is  often  pres- 
ent, which  can  be  removed.  Medical  advice  should 
at  once  be  sought. 

(2) 
THE   END 


/IDemoran^a. 


/lDemorau&a. 


/lDemorant)a. 


/IDemoranba. 


/IDemoran5a. 


/iDemoran^a. 


/IDemoran&a. 


/IDemoran&a. 


THE  DISEASES  OF  INFANCY 
AND  CHILDHOOD 

By   L.   emmet   holt,    A.  M.,   M.  D. 

Professor  of  Diseases  of  Children  in  the  College  of  Physicians  and  Surgeons  (Columbia 

University)  ;  Consulting  Physician  to  the  New  York  Infant  Asylum, 

and  to  the  Hospital  for  Ruptured  and  Crippled. 

SECOND   EDITION,    REVISED    AND   ENLARGED,    WITH   TWO 

HUNDRED  AND   TWENTY-FIVE  ILLUSTRATIONS, 

INCLUDING  NINE  COLORED  PLATES. 

Cloth,    $6.00;     Half   Leather,    $6.50. 

Sold  only  by  subscription. 

"No  radical  departure  from  the  previous  edition  has  been  instituted 
in  this  the  second  edition.  The  material  has,  however,  undergone  a 
thorough  revision,  with  the  addition  of  new  and  thoroughly  tried  methods 
of  diagnosis  and  treatment  which  have  been  accepted  since  the  appear- 
ance of  the  previous  edition.  The  most  noteworthy  change  has  been  in 
the  chapter  on  Milk  and  Infant  feeding.  This  section  has  been  completely 
rewritten,  with  the  addition  of  much  new  and  valuable  material  in 
accord  with  the  great  advance  made  in  this  important  branch  of  pediat- 
rics. Old  illustrations  have  been  replaced  by  newer  and  better  ones. 
New  charts  and  diagrams,  with  twenty-one  additional  illustrations,  en- 
hance the  value  of  an  already  accepted  standard  work." — Yale  Medi- 
cal Journal. 

"  Holt  is  recognized  as  one  of  the  foremost  authorities  on  pediatrics 
of  America,  and  therefore  of  the  world.  He  has  made  a  very  extensive 
first-hand  study  of  the  care  of  children  and  their  diseases,  and  so  writes 
from  a  mind  replete  with  the  clinical  pictures  of  suffering  childhood.  The 
work  is  complete  from  every  practical  standpoint,  and  the  text  embraces 
1 161  octavo  pages.  The  student  or  practitioner  who  has  Holt  at  hand 
need  hardly  ever  be  at  a  loss  for  a  reliable  line  of  treatment  in  his 
pediatric  practise." — Denver  Medical  Times. 

"  The  changes  within  the  past  five  years  have  not  been  very  exten- 
sive, yet  the  many  new  facts  that  have  come  out  in  the  rapidly  advancing 
science  of  pediatrics  have  here  all  received  their  share  of  careful  and 
judicial  treatment. 

"  The  extremely  practical  question  of  infant  feeding,  as  is  well  known, 
has  been  a  subject  of  special  study  by  the  author,  and  one  in  which 
medical  advances  have  been  made  very  largely  identified  with  his  name. 
It  is  a  pleasure  to  find  the  subject  handled  in  a  text-book  in  a  compre- 
hensive and  yet  common-sense  manner." — New  York  Medical  News. 

D.     APPLETON    AND     COMPANY,     NEW    YORK. 


PRACTICAL    DIETETICS, 

WITH  SPECIAL  REFEREh'CE  TO  DIET  IN  DISEASE. 

By  W.  oilman  THOMPSON,  M.  D., 

Professor  of  Medicine  in  the  Cornell  Medical  College  of  the  City  of  New  York  ; 
Visiting  Physician  to  the  Presbyterian  and  Bellevue  Hospitals,  New  York. 

LARGE  OCTAVO,  EIGHT  HUNDRED  AND  FOURTEEN 

PAGES,  ILLUSTRATED. 

Cloth,  95.00. 

SECOND  REVISED  EDITION.     SOLD  ONLY  BY  SUBSCRIPTION. 


"  This  is  at  once  the  best  and  most  exhaustive  book  upon  this 
subject  with  which  we  are  familiar.  The  best,  because,  in  the  first 
place,  it  is  written  by  a  teacher  of  therapeutics  who  knows  the  needs 
of  the  practicing  physician,  and  yet  who  has  taught  in  previous 
years  as  a  professor  of  physiology  all  that  one  needs  to  know  in  regard 
to  the  principles  of  digestion  and  assimilation.  For  this  reason  the 
author  is  unusually  well  qualified  to  prepare  a  useful  manual,  but  it 
is  not  until  one  has  perused  the  volume  that  he  thoroughly  grasps 
the  scope  and  depth  of  the  manner  in  which  Dr.  Thompson  has 
treated  nis  subject." — TTierapeutic  Gazette. 

"  The  subject  of  the  dietetic  treatment  of  disease  is  not  an  at- 
tractive one.  This  fact  explains,  no  doubt,  the  comparatively  little 
attention  given  it  in  college  curriculum  and  daily  study.  When  one 
proceeds  to  examine  the  valuable  contributions  to  this  subject,  the 
scientific  investigations  which  have  been  made  by  the  United  States 
Department  of  Agriculture  at  various  experiment  stations  in  all  parts 
of  the  country,  he  is  convinced  that  it  is  high  time  to  look  into  the 
matter  pretty  thoroughly.  This  book  is  of  value  for  its  summary 
of  the  latter  and  its  application  of  the  knowledge  to  the  treatment 
of  the  disease." — Brooklyn  Medical  Journal. 

"  Diet  in  disease  is  most  expansively  considered,  and  complete 
and  reliable  dietaries  for  every  ailment  are  suggested.  The  dietetic 
errors  responsible  for  a  large  number  of  diseases  are  also  fully  dis- 
cussed. Altogether,  it  is  perhaps  the  best  work  extant  on  the  sub- 
ject of  dietetics." — Sahnemannian  Monthly. 

"A  good  book  and  a  practical  one." — Canadian  Practitioner  and 
Review. 

"  In  the  seven  years  which  have  elapsed  since  the  first  appearance 
of  this  standard  text-book  there  have  not  been  the  many  and  impor- 
tant changes  in  dietetics  that  other  departments  of  our  therapeutics 
have  undergone.  Nevertheless,  Dr.  Thompson  has  revised  much  that 
was  published  in  the  first  edition,  and  has  introduced  into  this  one 
the  results  of  more  recent  studies  in  the  economic  values  of  various 
dietaries.  The  general  arrangement  of  the  work  is  unchanged." — 
Ifew  Fork  Medical  Journal. 


D.  APPLETON  AND  COMPANY,  NEW  YORK. 


THE  DISEASES  OF  THE  STOMACH. 

By  Dr.  C.  A.  EWALD, 

Extraordinary  Professor  of  Medicine  at  the  University  of  Berlin. 

Translated  and  edited,  with  numerous  Additions,  from  (he  Third 

German  Edition, 

By  morris  manges,  A.  M.,  M.  D., 

Aseistant  ViBiting  Physician  to  Mount  Sinai  Hospital ;  Lecturer  on  General 
Medicine,  New  York  Polyclinic,  etc. 

This  work  has  been  thoroughly  revised,  rearranged,  largely  rewritten, 
and  brought  up  to  date  from  the  most  recent  literature  on  the  subject. 

8vo.     C02  pages.     Sold  by  subscription.     Cloth,  $5.00 ;  sheep,  $6.00. 

"  In  giving  the  medical  profession  this  second  revised  translation  of  Professor 
Ewald's  treatise  on  the  Diseases  «f  the  Stomach,  Dr.  Manges  has  placed  the  pro- 
fession under  even  greater  obligations  than  we  owed  for  the  first.  The  first  trans- 
lation was  then  an  almost  exhaustive  treatise,  and  now,  with  so  much  new  and 
valuable  data  added,  the  work  is  a  sine  qua  twn."— Atlanta  Medical  and  Surgical 
Journal. 

"  This  work  as  it  now  stands  Is  the  best  on  the  subject  of  stomach  diseases  In 
the  English  language.  No  physician's  library  is  complete  without  it.  It  is  in 
every  way  well  adapted  to  the  requirements  of  the  general  practitioner,  although 
complete  enough  to  meet  also  the  requirements  of  the  specialist. " — American 
Medico- Surgical  Bulletin. 

"  The  present  American  edition  is  a  i)eculiarly  valuable  one,  as  the  editor. 
Dr.  Manges,  has  done  his  work  in  a  thoroughly  creditable  manner.  Eis  numer- 
ous notes,  additions,  and  new  illustrations  have  made  the  book  a  classic  one. 
Under  these  circumstances  it  should  find  a  place  in  the  library  of  every  Amer- 
ican physician,  as  their  clientile  Is  composed  of  such  a  large  proportion  of  patients 
suffering  from  gastric  complaints  and  more  or  less  improper  medication  which 
most  often  ends  in  failure.  There  is  no  doubt  that  more  properly  directed  efforts 
in  the  proper  direction,  as  outlined  in  Ewald's  book,  would  soon  remove  from 
Americans  the  reputation  of  being  a  nation  of  dyspeptics."— <S<.  LouU  Medical 
and  Surgical  Journal. 

"Dr.  Ewald's  book  has  met  with  a  very  cordial  reception  by  the  medical  pro- 
fession. Within  a  short  period  three  editions  have  appeared,  and  translations 
published  in  England,  Spain,  France,  Italy,  and  the  United  States.  To  the  pres- 
ent edition  the  author  has  not  only  added  considerable  new  matter,  but  he  has 
also  entirely  rewritten  the  work.  The  arrangement  of  the  chapters  has  been 
somewhat  changed,  and  many  new  personal  observations  and  therapeutic  experi- 
ences added.  The  desirability  of  surgical  interference  is  carefully  considered,  and 
the  pros  and  cons  given  so  far  as  would  be  necessary  to  enable  a  physician  to 
determine  whether  the  aid  of  the  surgeon  might  be  required.  The  translator  has 
done  his  work  well,  and  has  Incorporated  much  new  matter  Into  the  text  and 
footnotes."— iVor^A  American  Journal  of  nonuxopathy. 

D.  APPLETON  AND   COMPANY.  NEW  YORK 


A  TREATISE  ON  THE 
DISEASES  OF  THE 

NOSE  AND  THROAT 

By  ERNEST  L  SHURLY,  M.  D. 

Professor  of  Laryngology  and  Clinical  Medicine  in  the  Detroit  College  of 

Medicine  ;  Laryngologist  to  Harper  Hospital,  to  St.  Mary's 

Hospital,  and  the  Woman's  Hospital,  etc. 

With  Numerous  Illustrations  and  Six  Colored  Plates 

'  8vo.    Cloth,  $5.00 

"  This  is  a  recent  work  designed  for  the  general  practitioner  and 
students.  It  is  well  illustrated,  and  written  in  a  plain,  concise  manner, 
and  should  be  greatly  appreciated  by  the  medical  profession.  It  is  a 
good  acquisition  to  any  library,  either  that  of  a  specialist  or  a  general 
practitioner." — Columbus  Medical  Journal,  Columbus,  Ohio. 

"  The  announcement  in  the  Introduction  that  '  this  volume  has  been 
prepared  for  the  perusal  of  the  general  practitioner  and  medical  student 
rather  than  for  the  specialist  in  laryngology'  is  significant.  It  means 
that  the  work  is  designed  to  be  an  aid  to  those  who  do  not  devote 
themselves  exclusively  to  this  department  of  medicine,  but  who  gener- 
ally are  the  first  to  see  and  treat  all  cases  of  the  common  affections  of 
these  parts." — St.  Louis  Clinique,  St.  Louis,  Mo. 

"This  is  a  good  book  for  general  practitioners.  It  is  written  from 
the  standpoint  of  experience  or  observation.  It  is  thoroughly  systematic 
in  its  arrangement.  The  writings  of  the  best  authorities  have  been  freely 
consulted  and  quoted  whenever  necessary.  The  student  can  easily  fol- 
low the  sound  teachings  of  the  author,  who  makes  his  points  clear  and 
distinct.  The  illustrations  are  well  selected,  showing  operations,  instru- 
ments, general  appearances  of  parts  diseased,  and  pathological  condi- 
tions under  the  microscope,  etc." — Virginia  Medical  Semi-Monthly, 
Richmond,  Va. 


D.     APPLETON     AND     COMPANY,      NEW     YORK 


'HEARTILY  RECOMMENDED  TO  ALL  WHO  HAVE  TO 
CARE  FOR  THE  SICK,'*— Newark  {N.J.)  Nem)s. 


A  Text-Book  of  Nursing. 

For  the  use  of  Training  Schools,  Families,  and 
Private  Students.  Compiled  by  Clara  S.  Weeks- 
Shaw.  Third  Edition,  revised  and  enlarged.  With 
many  Illustrations.     i2mo.     Cloth,  $1.75. 

This  book,  first  introduced  to  the  public  by  Prof. 
Edward  L.  Youmans,  to  whose  most  kind  encouragement 
and  assistance  it  owed  its  existence,  is  now  for  the  second 
time  revised  and  brought  up  to  date  under  the  supervision 
of  his  niece,  Dr.  Alice  C.  Youmans.  It  follows  the  same 
practical  lines  as  the  earlier  editions  and,  until  something 
more  comprehensive  is  offered,  it  is  hoped  will  continue  to 
be  of  use  to  nurses  both  amateur  and  professional. 

ITS   HIGH    STANDING. 
"  A  valuable  book." — New  York  American. 
"  It  covers  the  whole  subject." — Philadelphia  Press. 
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"  It  has  the  recommendations  of  the  highest  medical  authorities." 

— Chicago  Tribune. 
"  Has  long  been  known  among  nurses   as  the   most   reliable   and 
comprehensive  work  of  its  kind." — Nerv  York  Commercial  Advertiser. 


D.       APPLETON     AND       COMPANY,      NEW      YORK. 


THE  TEETH  IN  HEALTH  AND  DECAY. 

The  Care  of  the  Teeth. 

By  S.  A.  Hopkins,  M.D,,  D.D.S.,  Professor  of 
Theory  and  Practise  of  Dentistry  in  Tufts  College 
Dental  School,  Boston,  Mass.  Illustrated.  i2mo. 
Cloth,  75  cents  net ;  postage,  7  cents  additional. 

The  author  points  out  in  a  concise  manner  how  decay 
of  the  teeth  may  be  prevented  and  dental  operations  re- 
duced to  a  minimum.  The  dentist  will  find  much  that  will 
be  useful  in  his  practise,  and  just  the  suggestions  to  make 
to  his  patients  when  urging  upon  them  the  importance  of 
proper  care  of  the  teeth.  No  physician  can  read  it  without 
an  awakening  sense  of  the  important  bearing  diseased  teeth 
have  upon  the  general  health ;  nor  can  he  fail  to  gain  many 
practical  ideas  that  will  be  of  immense  value  in  his  practise. 
To  mothers  of  growing  children  the  book  will  be  most  valu- 
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be  done  to  improve  the  teeth,  and  gives  practical  directions 
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dren. It  is  also  shown  how  the  teeth  of  adults  may  be  pre- 
served, and  how  many  dental  operations  may  be  avoided. 
The  book  is  interestingly  written  in  plain  language. 

TABLE   OF  CONTENTS. 

Chapter  I.  History  of  Dentistry — Uses  of  Teeth.  II.  Cause  of 
Decay.  III.  Predisposing  Causes — Lack  of  Exercise.  IV.  Food. 
V.  Food  (continued).  VI.  Eating  Slowly.  VII.  Irregularities,  VIII. 
Other  Mouth  Disturbances.  IX.  Prevention  of  Caries  or  Decay.  X. 
Brushing,  Mouth-Washes,  etc.  XI.  Toothache  and  the  Tefcth  of  the 
Poor.     XII.  Anatomy. 

D.     APPLETON     AND     COMPANY,     NEW    YORK. 


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Notes  on  Nursing :  What  it  is,  and  what  it  is  not. 

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— From  the  Preface. 

D.  APPLETON  and  company,  new  YORK. 


SICKNESS,  HYGIENE,  AND    HEALTH. 


In  Sickness  and  in  Health. 

A  Manual  of  Domestic  Medicine  and  Surgery,  Hygiene, 
Dietetics,  and  Nursing,  dealing  in  a  practical  way  with  the 
problems  relating  to  the  maintenance  of  health,  the  prevention  and 
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Edited  by  J.  West  Roosevelt,  M.D.,  late  Physician  in  Charge  of 
Seton  Hospital  for  Consumptives;  Visiting  Physician  to  Bellevue 
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York.  Complete  in  one  volume  of  over  i,ooo  pages.  Illustrated 
vvith  4  Colored  Plates  and  numerous  Engravings.  Full  Analytical 
Index.     8vo.     Handsome  cloth  binding,  $5.00. 

Health  Primers. 

Edited  by  J.  Langdon  Down,  M.D.,  F.R.C.P.;  Henry 
Power,  M.B.,  F.R.C.S. ;  J.  Mortimer-Granville,  M.D.  ; 
John  Tweedy,  F.R.C.S.  In  square  i6mo  volumes.  Cloth, 
40  cents  each. 

I.  Exercise  and  Training. 
II.  Alcohol  :  Its  Use  and  Abuse. 

III.  Premature  Death  :  Its  Promotion  or  Prevention. 

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VI,  Baths  and  Bathing. 
VII.  The  Skin  and  its  Troubles. 
VIII.  The  Heart  and  its  Functions. 
IX.  The  Nervous  System. 

Though  it  is  of  the  greatest  importance  that  books  upon  health  should  be 
in  the  highest  degree  trustworthy,  it  is  notorious  that  most  of  the  cheap  and 
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Health  Primers  of  a  character  that  should  be  entitled  to  the  fullest 
confidence. 

D.      APPLETON     AND     COMPANY,     NEW    YORK. 


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INTERNATIONAL   EDUCATION   SERIES. 
Later  Infancy  of  the  Child. 

By  Gabriel  Compayr^.  Translated  by  Mary  E. 
Wilson.  Vol.  53.  Part  II  of  Vol.  35.  Price,  $1.20  net ; 
postage  lo  cents  additional. 

This  book  completes  the  translation  of  Professor  Compayre's  well, 
known  essay,  "  L'  Evolution  Intellectuale  et  Morale  de  L'Enfant." 
It  brings  together,  in  a  systematic  pedagogic  form,  what  is  known  of 
the  development  of  infant  children  so  far  as  the  facts  bear  on  early 
education.  Professor  Compayre's  treatise  is  one  of  the  most  sagacious 
and  fruitful  products  of  the  modern  attention  to  child  study.  Since 
the  publication  of  the  first  volume  (in  1896),  investigation  in  this 
fascinating  field  has  gone  forward  at  a  rapid  pace,  and  an  immense 
mass  of  new  material  is  now  available.  This  has  been  utilized  and 
interpreted  in  its  manifold  applications. 

The  interdependence  of  the  two  aspects  of  education — the  study  of 
the  ideals  of  civilization  and  the  study  of  the  child  (to  discover  what 
rudimentary  tendencies  are  favorable  or  unfavorable  to  culture,  and  to 
ascertain  the  best  methods  of  encouraging  the  one  and  of  suppressing 
the  other) — this  interdependence  has  been  properly  balanced. 

The  chapters  in  this  volume  discuss  judgment  and  reasoning,  learn- 
ing to  talk,  voluntary  activity — walking  and  play,  the  development  of 
the  moral  sense,  weak  and  strong  points  of  character,  morbid  tenden- 
cies,  etc.,  and  the  evolution  of  the  sense  of  selfhood  and  personality 
This  part  is  even  more  valuable  than  that  already  published  in  Vol. 
XXXV,  and  teachers  everywhere  will  welcome  it  as  a  highly  suggestive 
contribution. 

D.  APPLETON  AND  COMPANY,  NEW  YORK. 


University  of  California 

SOUTHERN  REGIONAL  LIBRARY  FACILITY 

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